Due to hormonal changes, pregnancy is a frequent provocateur of imbalance in glucose metabolism in women. By causing insulin resistance, it leads to the development of gestational diabetes (GDM) in 12% of women.
Developing after 16 weeks, gestational diabetes, whose effects on the fetus and the mother’s health can be very dangerous, causes severe consequences and death.
What is dangerous for a child gestational diabetes during pregnancy?
An imbalance of the compensatory mechanism of carbohydrate metabolism leads to the development of GDM. This pathology begins during pregnancy and is initially asymptomatic, manifested in most cases already in the third trimester.
Almost half of pregnant women subsequently develop GDM into a real type II diabetes. Depending on the degree of compensation of the GDS, the effects are manifested differently.
The most threatened is the non-compensated form of the disease. It is expressed:
- the development of fetal malformations caused by glucose deficiency. An imbalance of carbohydrate metabolism in the mother at an early stage of pregnancy, when the fetus has not yet formed a pancreas, causes an energy deficit of cells, leading to the formation of defects and low weight. Polymer - a characteristic sign of insufficient glucose intake, allowing to suspect this pathology;
- diabetic fetopathy - a pathology that develops as a result of the action of diabetes on the fetus and is characterized by metabolic and endocrine abnormalities, polysystem lesions;
- deficiency of surfactant production, which causes disorders of the respiratory system;
- development of postpartum hypoglycemia, provoking neurological and mental disorders.
Diabetic fetal fetopathy
Pathology, called diabetic fetopathy (DF), develops as a result of the influence of diabetes of the mother on the development of the fetus.
It is characterized by dysfunction of the internal organs of the child - vessels, pancreas, kidneys, respiratory system, causing neonatal hypoxia, hypoglycemia, acute heart failure, the development of type II diabetes and other serious complications in a baby, even fatal.
Intrauterine hypertrophy (macrosomia) is the most common manifestation of DF. Macrosomies develop as a result of an excess supply of glucose from the mother through the placenta to the fetus.
Excess sugar under the action of insulin, produced by the pancreas of the fetus, is converted into fat, causing its deposition on the organs and too rapid an increase in the body weight of the child — more than 4 kg.
Body imbalance is an external hallmark of children with macrosomia. They have a disproportionately large body in relation to the head and limbs, a large belly and shoulders, blue-red, inflamed skin, covered with a petechial rash, cheese-like lubricant, hair in the ears.
When diagnosing macrosomia, carrying out natural childbirth is not recommended due to the high level of trauma. In addition, its presence increases the risk of encephalopathy, leading to the development of mental retardation or death.
The characteristic symptoms of DF in newborns also include jaundice, which is manifested by yellowing of the skin, eye sclera, and liver dysfunction.
Unlike physiological jaundice of newborns, which has similar symptoms and is able to go on its own after a week, the appearance of jaundice in babies with diabetic fetopathy requires complex therapy, since it indicates the development of liver pathologies.
HypoglycemiaThe termination of glucose proceeds from mother to child after his birth against the background of increased insulin secretion by his pancreas leads to the development of neonatal hypoglycemia in the newborn - another symptom of DF.
Hypoglycemia aggravates the development of neurological abnormalities in children, affects their mental development.
To avoid hypoglycemia and its consequences - convulsions, coma, brain damage - from the moment of delivery in newborns, the state of sugar level is taken under control, in case of its fall, glucose is injected into the baby in / in.
Low levels of calcium and magnesium in the blood.
Chronically high glucose levels during pregnancy cause an imbalance of mineral metabolism, causing hypocalcemia and hypomagnesia in the newborn.
The peak of a decrease in the level of calcium in the blood to 1.7 mmol / l and less in a baby is observed 2-3 days after birth.
This condition is manifested by hyper-excitability - the newborn twitches with limbs, cries out sharply, tachycardia and tonic convulsions appear. Such symptoms occur in the newborn and with hypomagnesemia. It develops when the magnesium concentration reaches a level below 0.6 mmol / l.
The presence of such a condition is diagnosed using an ECG and a blood test. In 1/5 of newborns who have suffered convulsions due to neonatal hypomagnesemia or hypocalcemia, neurological disorders are observed. For their relief, babies are given IM / IV administration of magnesium-calcium solutions.
Children with DF are more likely to suffer from chronic intrauterine hypoxia.
Due to inadequate synthesis of pulmonary surfactant, which ensures the expansion of the lungs in newborns during the first breath, they may develop respiratory disorders.
This implies the appearance of shortness of breath, respiratory arrest.
GDM is one of the common causes of a frozen fetus, spontaneous abortion, or early childbirth.
Large fruit developed as a result of macrosomia is more than 4 kg, in 24% of cases it causes premature birth, which often leads to the development of respiratory distress syndrome in newborns against the background of a delay in maturation in the lung surfactant system.
What threatens diabetes pregnant?
Uncompensated GSD causes severe toxicosis in pregnant women in the third trimester. Preeclampsia and eclampsia are the most dangerous complications for a woman. When they are threatened, a pregnant woman is hospitalized for resuscitation and premature delivery.
Changes in the vessels due to a violation of carbohydrate metabolism - the cause of the development of gestosis.
Increased blood pressure and edema are its usual manifestations in 30-79% of women. Combined with other pathologies, it can cause serious consequences. For example, a combination of preeclampsia and DF, leads to uremia.
In addition, the development of preeclampsia causes loss of protein in the urine, the appearance of dropsy of pregnancy, nephropathy, eclampsia, creates a threat to the life of the mother.
The development of severe preeclampsia contributes to:
- diabetes for more than 10 years;
- labile diabetes before pregnancy;
- infection of the urinary tract during pregnancy.
Women with hypertension are included in the category at risk of getting GDM during pregnancy.
In pregnant women, there are 2 types of hypertension:
- chronic - it is observed in a woman before conceiving a child or before the 20th week of pregnancy and is the cause of 1-5% of complications during the gestation period;
- gestationalthat appears in 5-10% of pregnant women after the 20th week and lasts another 1.5 months. after childbirth. Hypertension occurs most often in multiple pregnancies.
A complication that occurs in 7% of pregnant women after the 20th week, of which a quarter - in the postpartum period during the first 4 days.
Diagnosed clinically by protein in the urine. If untreated, it progresses to eclampsia (1 case per 200 women), leading to death.
The main is in / in the introduction of magnesium sulfate and early delivery.
The risk of spontaneous miscarriage with diabetes increases significantly. An increase in blood clotting as a result of insulin deficiency leads to the development of placental insufficiency, the emergence of thrombotic pathologies and abortion.
How does GSD affect childbirth?
In pregnant women with a diagnosis of HSD, the term of labor is determined depending on the severity of the disease, its degree of compensation, and obstetric complications.
Most often, childbirth induce at 37-38 week, if the weight of the fetus exceeds 3.9 kg. If the weight of the fetus is less than 3.8 kg, the pregnancy will be extended up to 39-40 weeks.
With the help of ultrasound, fetal weight and its conformity to the size of the female pelvis, the possibility of natural childbirth, is determined.
If the condition of the mother and baby allow, delivery is carried out in a natural way with gradual anesthesia, hourly measurement of the glycemic level, insulin therapy, treatment of placental insufficiency, cardiotochographic control.
Consequences of labor induction in GSDDiagnosing mother's HSD increases the likelihood of complications during childbirth for both herself and the baby.
Their risk is the lowest if a cesarean section or operative vaginal delivery is performed at week 39.
Stimulation of labor up to week 39 is justified only in the presence of some specific symptom indicating the appearance of a risk of stillbirth.
For both, the risk of complications is minimal if labor activity began spontaneously at 38-39 weeks.
Treatment and prevention of complications during pregnancy
How women will be pregnant in diabetes depends on their level of self-control and the correction of hyperglycemia. The treatment regimen depends on the individual indicators of the mother and is selected in strict accordance with them.
Hospitalization for the purpose of examination is recommended to be carried out 3 times during pregnancy:
- in the first trimester in the case of diagnosing pathology;
- on the 20th week - for the correction of the therapeutic plan in accordance with the state of the mother and the fetus;
- on the 36th to prepare for the process of childbirth and the choice of the optimal method for their implementation.
In addition to controlling glucose levels and conducting compensatory therapy, pregnant women with HJD are also given a special diet and exercise complex.
Prevention of complications of GDM suggests:
- timely detection of diabetes and pre-diabetes state and hospitalization, which allows to conduct a survey and adjust the treatment;
- early detection of DF using ultrasound;
- careful monitoring and correction of glucose from the first day of detection of diabetes;
- observance of the schedule of visits to the gynecologist.
Risk factors and danger of gestational diabetes in the video:
Earlier detection of GSD and competently conducting compensatory treatment during the entire period of pregnancy will be the key to minimal complications and consequences for both the mother and her baby.