How to help gestational diabetes

Gestational Diabetes and Pregnancy | CDC

Gestational diabetes is a type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant. Some women have more than one pregnancy affected by gestational diabetes. Gestational diabetes usually shows up in the middle of pregnancy. Doctors most often test for it between 24 and 28 weeks of pregnancy.

Often gestational diabetes can be managed through eating healthy foods and regular exercise. Sometimes a woman with gestational diabetes must also take insulin.

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Blood sugar that is not well controlled in a woman with gestational diabetes can lead to problems for the pregnant woman and the baby:

An Extra-Large Baby

Diabetes that is not well controlled causes the baby’s blood sugar to be high. The baby is “overfed” and grows extra-large. Besides causing discomfort to the woman during the last few months of pregnancy, an extra-large baby can lead to problems during delivery for both the mother and the baby. The mother might need a C-Section to deliver the baby. The baby can be born with nerve damage due to pressure on the shoulder during delivery.

C-Section (Cesarean Section)

A C-section is an operation to deliver the baby through the mother’s belly. A woman who has diabetes that is not well controlled has a higher chance of needing a C-section to deliver the baby. When the baby is delivered by a C-section, it takes longer for the woman to recover from childbirth.

High Blood Pressure (Preeclampsia)

When a pregnant woman has high blood pressure, protein in her urine, and often swelling in fingers and toes that doesn’t go away, she might have preeclampsia. It is a serious problem that needs to be watched closely and managed by her doctor. High blood pressure can cause harm to both the woman and her unborn baby. It might lead to the baby being born early and also could cause seizures or a stroke (a blood clot or a bleed in the brain that can lead to brain damage) in the woman during labor and delivery. Women with diabetes have high blood pressure more often than women without diabetes.

Low Blood Sugar (Hypoglycemia)

People with diabetes who take insulin or other diabetes medications can develop blood sugar that is too low. Low blood sugar can be very serious, and even fatal, if not treated quickly. Seriously low blood sugar can be avoided if women watch their blood sugar closely and treat low blood sugar early.

If a woman’s diabetes was not well controlled during pregnancy, her baby can very quickly develop low blood sugar after birth. The baby’s blood sugar must be watched for several hours after delivery.

5 Tips for Women with Gestational Diabetes

Eat Healthy Foods
Eat healthy foods from a meal plan made for a person with diabetes. A dietitian can help you create a healthy meal plan. Learn more about diabetes meal planning.
A dietitian can also help you learn how to control your blood sugar while you are pregnant. To find a registered dietician near you, please visit The Academy of Nutrition and Dietetics website.

Exercise Regularly
Exercise is another way to keep blood sugar under control. It helps to balance food intake. After checking with your doctor, you can exercise regularly during and after pregnancy. Get at least 30 minutes of moderate-intensity physical activity at least five days a week. This could be brisk walking, swimming, or actively playing with children.Learn more about physical activity during pregnancy »
Monitor Blood Sugar Often
Because pregnancy causes the body’s need for energy to change, blood sugar levels can change very quickly. Check your blood sugar often, as directed by your doctor.
Take Insulin, If Needed
Sometimes a woman with gestational diabetes must take insulin. If insulin is ordered by your doctor, take it as directed in order to help keep blood sugar under control.
Get Tested for Diabetes after Pregnancy
Get tested for diabetes 6 to 12 weeks after your baby is born, and then every 1 to 3 years.For most women with gestational diabetes, the diabetes goes away soon after delivery. When it does not go away, the diabetes is called type 2 diabetes. Even if the diabetes does go away after the baby is born, half of all women who had gestational diabetes develop type 2 diabetes later. It’s important for a woman who has had gestational diabetes to continue to exercise and eat a healthy diet after pregnancy to prevent or delay getting type 2 diabetes. She should also remind her doctor to check her blood sugar every 1 to 3 years.

Women who had gestational diabetes or who develop prediabetes can also learn more about the National Diabetes Prevention Program (National DPP), CDC-recognized lifestyle change programs. To find a CDC-recognized lifestyle change class near you, or join one of the online programs.

More Information

Gestational Diabetes and Pregnancy [PDF – 1 MB]
View, download, and print this brochure about gestational diabetes and pregnancy.

For more information on gestational diabetes, visit the American Diabetes Association’s website.

Diabetes
Before Pregnancy
Healthy Pregnancy
Birth Defects
CDC’s National Center on Birth Defects and Developmental Disabilities

Gestational Diabetes | CDC

Follow a healthy eating plan to nourish you and your baby.

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes. Every year, 2% to 10% of pregnancies in the United States are affected by gestational diabetes. Managing gestational diabetes will help make sure you have a healthy pregnancy and a healthy baby.

What Causes Gestational Diabetes?

Gestational diabetes occurs when your body can’t make enough insulin during your pregnancy. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy.

During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin.

All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant. They start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.

About 50% of women with gestational diabetes go on to develop type 2 diabetes, but there are steps you can take to prevent it. Talk to your doctor about how to lower your risk and how often to have your blood sugar checked to make sure you’re on track.

Symptoms and Risk Factors

Gestational diabetes typically doesn’t have any symptoms. Your medical history and whether you have any risk factors may suggest to your doctor that you could have gestational diabetes, but you’ll need to be tested to know for sure.

Testing for Gestational Diabetes

It’s important to be tested for gestational diabetes so you can begin treatment to protect your health and your baby’s health.

Gestational diabetes usually develops around the 24^th week of pregnancy, so you’ll probably be tested between 24 and 28 weeks.

If you’re at higher risk for gestational diabetes, your doctor may test you earlier. Blood sugar that’s higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes.

Prevention

Before you get pregnant, you may be able to prevent gestational diabetes by losing weight if you’re overweight and getting regular physical activity.

Don’t try to lose weight if you’re already pregnant. You’ll need to gain some weight—but not too quickly—for your baby to be healthy. Talk to your doctor about how much weight you should gain for a healthy pregnancy.

Treatment for Gestational Diabetes

You can do a lot to manage your gestational diabetes. Go to all your prenatal appointments and follow your treatment plan, including:

Checking your blood sugar to make sure your levels stay in a healthy range.
Eating healthy food in the right amounts at the right times. Follow a healthy eating plan created by your doctor or dietitian.
Being active. Regular physical activity that’s moderately intense (such as brisk walking) lowers your blood sugar and makes you more sensitive to insulin so your body won’t need as much. Make sure to check with your doctor about what kind of physical activity you can do and if there are any kinds you should avoid.
Monitoring your baby. Your doctor will check your baby’s growth and development.

If healthy eating and being active aren’t enough to manage your blood sugar, your doctor may prescribe insulin, metformin, or other medication.

Gestational diabetes in pregnancy - treatment and diagnosis of diabetes in pregnant women in Moscow, Clinical Hospital on Yauza

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Contents

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Specialists of the Yauza Clinical Hospital diagnose and treat gestational diabetes and its complications. For a comfortable pregnancy and the safety of the expectant mother and baby, we exercise strict control over the blood sugar level of a pregnant woman, if necessary, prescribe a specially designed diet and medications.

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About 7% of pregnant women have manifestations of gestational diabetes. In 50% of cases, the disease is asymptomatic
Gestational diabetes in pregnancy significantly increases the risk of pregnancy complications for both mother and fetus
Perinatal mortality increases by 2-3% with a combination of diabetes mellitus and pregnancy

Pregnancy diabetes (gestational diabetes) is an increase in blood glucose that first occurs during pregnancy but is not high enough to warrant a diagnosis of diabetes mellitus. These are hidden disorders of carbohydrate metabolism that threaten to develop into diabetes mellitus.

Pregnant blood glucose norm

During pregnancy, all women experience changes in insulin sensitivity and glucose tolerance. This is fine. The difference between the norm and pathology in the degree of change.

Blood tests for diabetes during pregnancy - norm and pathology

If the test of venous blood taken on an empty stomach shows a glucose level of more than 5.1 mmol / l, this is the norm for pregnant women.
From 5.1 to 7.0 mmol / l - gestational diabetes.
If 7.0 mmol / l or more - diabetes mellitus.
Testing capillary blood (taken from a fingerstick) for the diagnosis of gestational diabetes mellitus is not recommended.
If during an oral glucose tolerance test (when 75 g of glucose is taken orally during the study) after one hour the glucose level is more than 10. 0 mmol/l, and after two hours the blood glucose level is in the range of 7.8-8.5 mmol/l - then for pregnant women this is a normal indicator.

To better understand what gestational diabetes, or diabetes in pregnancy, is, you need to talk a little about hormonal changes in the body in pregnant women.

Causes of gestational diabetes

Hormonal changes that occur during pregnancy are associated with increased production of large amounts of steroid hormones. Some of them, such as cortisol and progesterone, have a significant effect on cell receptors, increasing their resistance to insulin.
This leads to an increase in blood glucose levels and requires a significant increase in insulin production by the pancreas. In cases where the compensatory capacity of the pancreas is not enough, sugar metabolism gets out of control and a condition called gestational diabetes or gestational diabetes develops.
This condition occurs quite often. Between 3 and 10% of pregnant women develop pathological insulin resistance leading to gestational diabetes.
Unlike diabetes mellitus diagnosed before pregnancy, pathological insulin resistance that occurs during pregnancy does not cause fetal malformations and in most cases does not require insulin treatment. But, nevertheless, uncompensated gestational diabetes can significantly complicate the course of pregnancy.

Specialists of the Yauza Clinical Hospital diagnose, treat and prevent diabetes in pregnant women and its complications, such as impaired fetal growth. The doctors of the Clinical Hospital on the Yauza strictly control the blood sugar level of a pregnant woman, if necessary, prescribe a specially designed diet. This ensures a comfortable pregnancy and the safety of the expectant mother and baby.

Pregnancy diabetes - consequences for the child

Large disproportionate fruit. The most important and frequent complication of gestational diabetes is fetal growth failure. Developing in conditions of increased blood glucose levels, which penetrate the fetoplacental barrier, the fetus is forced to compensate for the increased sugar level with its own insulin. Due to the fact that the structure of insulin and growth hormone are very similar, high levels of insulin stimulate the growth of the fetus. The problem is that a large fetus develops. In such a fetus, body proportions differ from those of normally developing newborns, in which the volume of the head is larger than the volume of the shoulder girdle. In fetuses with uncompensated gestational diabetes, the size of the shoulder girdle predominates, and the size of the abdomen increases. This leads to the fact that during childbirth after the fetus's head passes through the birth canal, the shoulders can get stuck (shoulder dystocia) and the child, along with the mother, can be severely injured or die.

Polyhydramnios or oligohydramnios. In addition, in gestational diabetes, the balance of the amount of amniotic fluid can be disturbed and either polyhydramnios or oligohydramnios develops. This is a serious risk factor for intrauterine fetal death or premature birth.

Underdevelopment of the lungs. In gestational diabetes, the lungs of the fetus mature later, as the production of surfactant (a special lubrication of the inner walls of the alveoli, where oxygen is exchanged in the lungs) is disrupted. Therefore, premature birth in gestational diabetes is especially dangerous.

Hypoglycemia and metabolic disorders in the fetus. Due to the constant increased production of its own insulin during pregnancy, immediately after birth, the child is in a state of hypoglycemia with electrolyte imbalance, which threatens his life.

All this dictates the need for the earliest possible detection of gestational diabetes in pregnant women, the level of sugar in the blood of a pregnant woman and to prevent the development of complications.

Diagnosis of diabetes in pregnant women at the Yauza Clinical Hospital

Signs of diabetes in pregnant women

Gestational diabetes in pregnancy is not usually associated with the classic symptoms of diabetes, such as thirst or excessive urination (polyuria).

Pregnancy tests for diabetes mellitus

First phase. At the first visit of a pregnant woman to a doctor at any time, she is tested for glucose levels in venous blood - fasting glucose, regardless of food intake, glycated hemoglobin. This is the first phase of research to detect diabetes mellitus or gestational diabetes in pregnant women. If diabetes mellitus is detected, the patient is referred for observation and treatment to an endocrinologist.

Second phase. For a period of 24-28 weeks, all patients who did not show identified disorders of carbohydrate metabolism at the first study are called for a glucose tolerance test (PGTT) to detect "hidden diabetes". This is done because the occurrence of gestational diabetes is associated with the development of insulin resistance under the influence of hormones produced by the placenta. Therefore, in the vast majority of cases, gestational diabetes develops in the second half of pregnancy after 24 weeks, when there is a peak in the production of placental hormones.

Glucose tolerance test

It is carried out to detect pathological insulin resistance, characteristic of latent diabetes in pregnant women. Pregnant women undergo a two-hour test, only in the laboratory.
During the 3 days leading up to the test, the woman should eat her usual diet, including carbohydrates (>150 g of carbohydrates per day), maintain her usual physical activity. The evening before testing, dinner should include 30-50 grams of carbohydrates.
On the day of the study, before the analysis, you should not smoke and take medications that can affect the level of glucose (vitamins, glucocorticoid hormones, iron preparations, which include carbohydrates, beta-agonists, beta-blockers). You can drink water.
Venous blood is taken on an empty stomach (after 8-14 hours of fasting, usually in the morning, before breakfast).
Then the patient takes a glucose solution (75 g).
And they take blood in an hour and two after the sugar load. Normally, the level of glucose in the blood after a sugar load should not exceed an hour later - 10 mmol / l, after 2 hours - 8.5 mmol / l.
If manifest diabetes mellitus is detected, the patient is referred to an endocrinologist, gestational diabetes mellitus is treated by an obstetrician-gynecologist or therapist.

Glucose tolerance test contraindications

Strict bed rest for a pregnant woman (until doctor's approval).
Pronounced toxicosis of pregnant women (with nausea and vomiting).
Acute infectious or inflammatory disease.
Exacerbation of chronic pancreatitis.
Dumping syndrome (syndrome of resected stomach).

Prenatal diabetes monitoring

Blood glucose monitoring, self-monitoring diary

When diagnosing gestational diabetes, it is necessary to establish strict control of sugar levels throughout the subsequent pregnancy and during childbirth. To do this, regularly examine the blood for sugar (glucose). In addition, the patient conducts self-monitoring using a glucometer.

It is recommended that a pregnant woman keep a diary of observations in which to record:

blood glucose level (normal <5.1 mmol/l),
the presence of ketone bodies in the urine, which is determined by test strips sold in a pharmacy (normally, ketone bodies are absent),
blood pressure readings (normal <130|80 mmHg),
fetal movements,
body weight,
diet.

Expert ultrasound

Conducting an expert ultrasound examination reveals signs of intrauterine suffering of the fetus (diabetic fetopathy), polyhydramnios. Most often, this is a sign of chronically elevated blood glucose levels, penetrating into the blood of the fetus. This requires urgent correction of the diet and normalization of the level of glycemia (blood sugar). If necessary, insulin therapy.

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Treatment of gestational diabetes

Diet for gestational diabetes

In most cases, it is sufficient to follow a special diet recommended by a nutritionist based on the body mass index of the pregnant woman and her taste preferences. The effectiveness of diet therapy is determined by the maintenance of normal blood glucose levels. Diet in pregnancy diabetes recommends:

Avoid simple carbohydrates - sweets, pastries, white bread, honey, sugar, jam, sweet drinks and fruits, ice cream.
Limit complex carbohydrates - cereals (semolina, rice - exclude), potatoes, corn, legumes, durum wheat pasta. Distribute their intake evenly over several meals throughout the day to eliminate starvation (causes the formation of ketone bodies).
Eat enough protein - meat, fish, seafood, poultry, mushrooms, eggs, hard cheese, dairy and sour-milk products of medium fat content (3-5%).
It is necessary to enrich the diet with fiber and vitamins - greens, vegetables (except for boiled carrots and beets), sweet and sour berries (excluding grapes).
Correctly choose fats, do not exceed their amount recommended by the doctor - vegetable oils (add to ready-made meals), nuts, seeds. Animal fats (butter, sausages) - limit.
When cooking, boil, stew, steam and bake dishes. Don't fry. Do not deep fry.

A detailed menu for a pregnant woman with gestational diabetes will be compiled by a doctor, taking into account the individual characteristics of each particular woman.
It is not worth using table No. 9 in its pure form for pregnant women with diabetes mellitus due to a significant restriction of its calorie content.
In detail, what you can eat with diabetes in pregnant women will be told by the doctor at an in-person consultation.

Pharmacotherapy

In cases where the diet fails to achieve the desired control of the level of glycemia in the blood, there are signs of a negative effect on the fetus - they resort to prescribing drugs - insulin. In case of diabetes in pregnant women, antidiabetic drugs in tablets should not be used. Insulin therapy is prescribed by an endocrinologist. Pregnant women with diabetes who are on insulin therapy are jointly managed by an endocrinologist, an internist and an obstetrician-gynecologist.

Physical activity

Patients are recommended regular physical activity - walking in the fresh air (at least 150 minutes per week), swimming.

Prenatal diabetes - childbirth

With a compensated course of gestational diabetes, normal development of the fetus and the condition of the woman, childbirth is carried out in time in a natural way. The question of early delivery, caesarean section may arise if there are relevant indications from the mother or fetus.

Specialists of the Yauza Clinical Hospital have included mandatory fetal development screenings and tests to diagnose sugar metabolism disorders in the pregnancy monitoring program. Recommendations are given on a special diet for women with manifestations of gestational diabetes. If necessary, strict glycemic control is carried out throughout pregnancy, ensuring its successful completion and the birth of a healthy child.

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More What is the problem?

Can dietary advice to pregnant women prevent the development of diabetes during pregnancy, known as gestational diabetes mellitus (GDM), which can cause health complications for women and their babies?

Why is this important?

Women with GDM have a higher risk of high blood pressure, protein in the urine (preeclampsia), and caesarean section. Their babies may grow large and, as a result, may be injured at birth or cause injury to their mothers during childbirth. In addition, there may be long-term health problems for women and their babies, including an increased risk of cardiovascular disease and type 2 diabetes. The number of women with this diagnosis is growing worldwide, so it is important to find simple and cost-effective ways to prevent the development of gestational diabetes.

Carbohydrates are the main nutrient influencing post-meal blood glucose levels. The glycemic index (GI) can be used to characterize the ability of carbohydrate-based foods to raise blood glucose levels after consumption. Certain diets, such as those low in fiber and high in the GI of food, may increase the risk of developing GDM. It has been suggested that dietary advice during pregnancy may help in preventing the development of GDM in women.

What evidence did we find?

We searched for studies published up to 3 January 2016 and included 11 randomized controlled trials involving 2786 pregnant women and their infants. The quality of the evidence was rated as low to very low and the overall risk of trial bias was unclear to moderate. Six trials compared dietary recommendations with standard management, four compared low GI versus moderate-high GI dietary recommendations, and one trial compared high-fiber dietary recommendations with standard recommendations.

Possible reduction in GDM in women who received dietary advice compared to standard management in five clinical trials (1279 women, very low quality of evidence ), although between women who received dietary advice with low GI compared with average - high GI in four studies (912 women, low-quality evidence ) showed no clear difference in GDM. Two studies (282 women) showed no clear difference between women who received nutritional advice compared with standard care for preeclampsia ( low-quality evidence ), although fewer women with high blood pressure during pregnancy received dietary advice ( low-quality evidence ). There was no clear difference between the groups of women who received low-GI, moderate-high GI dietary advice in terms of the number of babies born above normal for their gestational age in the three studies (777 babies, low-quality evidence ). Only one study comparing dietary advice and standard management reported the number of infants who died (either before or shortly after birth) with no deaths in this trial.

There were no clear differences in most other outcomes assessed in clinical trials comparing dietary advice with standard medical management, including caesarean section, perineal trauma, and infant skinfold thickness at six months. However, women who received dietary advice gained less weight during pregnancy in five trials (1336 women) ( low-quality evidence ).

Similarly, there are no clear differences in other outcomes found in clinical trials comparing low and moderate-high GI dietary recommendations, including caesarean section and weight gain during pregnancy. Clinical trials that compared high-fiber dietary advice and standard medical management found no difference in any outcome.

The included trials did not report many of the outcomes listed in this review, including outcomes related to the long-term health of women and their children (both in childhood and adulthood) and the use and cost of healthcare services.

What does this mean?

Dietary advice for pregnant women may prevent GDM.