UZ "Minsk City Clinical Endocrinological Center"
Endocrinologist, head of the department of Lazovtseva Olga Dmitrievna
Pregnancy, this is not only one of the most important events, but also a special condition that is associated with certain risks for the health of a woman and her unborn child. These risks are especially high if pregnancy occurs without the necessary preparation and against the background of an uncontrolled course of chronic diseases. One of these diseases is diabetes.
In diabetes mellitus, high glucose levels have a negative effect not only on the mother’s body, but also of the fetus. (table No. 1).
Table 1. The risks during pregnancy and the postpartum period due to diabetes mellitus.
Risks for mother with diabetes mellitus | Risk for the fetus/child |
1. More frequent complications of pregnancy (preeclampsia, eclampsia, infection, polyhydramnios, premature birth, inexcompanying) 2. Thromboembolic complications 3. Progressing of vascular complications 4. More frequent development of acute complications of diabetes: hypoglycemia, ketoacidosis 5. Maternal mortality | 1. Congenital malformations: anencephaly, microcephaly, congenital heart defects, renal anomalies 2. Respiratory distress syndrome 3. Hypoglycemic states of the newborn 4. Current injuries, large weight of the fetus 5. The risk of developing type 1 diabetes during life: about 2%- with type 1 diabetes in the mother, about 6%in the father and 30-35%- for both parents; obesity, arterial hypertension and metabolic syndrome (mechanism of fetal programming). 6. Intrauterine mortality 7. Early infant mortality |
In order for the above risks there is no or that they are minimized, appropriate preparation and self -control are necessary, i.e. necessaryplanningpregnancy. With your doctor, it is worth discussing the target levels of blood glucose indicators, glycated hemoglobin and other indicators and ways to achieve them. In each individual situation, target levels are selected individually, depending on the existing complications of diabetes and their stages, concomitant diseases, the presence of hypoglycemic conditions.
The main tasks of planning pregnancy are:
- Informing a woman and her family (with consent) about possible risks.
- The use of effective contraception until the target levels of glycemic control are achieved.
- Education at the School of Mell Association.
- Achieving target levels of glycemic control over 3-6 months. before conception (glycated hemoglobin less than 6.0-6.5%) and its maintenance during pregnancy; Control of the level of creatinine, albumin-coatinine ratio.
- Refusal of smoking, alcohol consumption, narcotic substances.
- Consultation of a gynecologist (the exclusion of IPPs and other conditions that can negatively affect the conception and outcome of pregnancy), a general practitioner (considering the issue of transferring drugs allowed to take and during pregnancy (if there are indications for this)); Monitoring the availability of planned vaccinations (taking into account the history of travel (for example, visiting areas endemic by the ZIK virus)), genetic screening.
- Consultation of an ophthalmologist with an examination of the fundus in an expanded pupil (at the stage of pregnancy planning, then in each trimester of pregnancy). Dynamic observation by an ophthalmologist is also recommended within 1 year after childbirth. Further, the frequency observation is determined individually.
- Women with excess body weight and obesity are recommended by a nutritional consultation to develop a power plan at the planning stage, during pregnancy and during breastfeeding. In the absence of the possibility of counseling with a nutritionist, it is recommended to discuss nutrition and physical activity with your attending physician.
- Recommended taking folic acid (at least 400 μg per day), potassium iodide 150 μg per day(subject to the lack of contraindications).
There is also a type of diabetes mellitus, which develops directly during pregnancyDiabetes gestational sugar (GSD)(table No. 2).
Diagnostics of the State Duma is carried out:
- at the first appeal of the pregnant woman to the specialty doctor at a period of up to 24 weeks-the determination of the glucose of venous plasma on an empty stomach is assigned;
- In the absence of carbohydrate metabolism disorders in the early stages of pregnancy, a glucosotolerant test (GTT) is carried out in 24–28 weeks, necessarily - if there are risk factors.
Diabetes gestational sugar often develops in the second and third trimesters of pregnancy.
Table 2. Criteria of gestational diabetes.
Indicator | Values corresponding to the GOD |
Glucose level on an empty stomach | ≥ 4.6 mmol/l in solid capillary or ≥ 5.1 mmol/l in venous blood plasma |
Glucose level after 1 hour when conducting GTT | ≥ 9.0 mmol/l in solid capillary or ≥ 10.0 mmol/l in venous blood plasma |
Glucose level after 2 hours when conducting GTT | ≥ 7.7 mmol/l in solid capillary or ≥ 8.5 mmol/l in venous blood plasma |
The diagnosis of HSD can be established with an increase in one of the indicators of the GTT. Upon receipt of an abnormal value, on an empty stomach - GTT is not carried out. Upon receipt of an abnormal value at the second point of the dough (after 1 hour) - the third dimension is not required.
GTT is not carried out if there are contraindications to it, which are determined by the attending physician.
Risk factors for the development of GSD:
- Excess body weight or obesity before pregnancy;
- history of gestational diabetes;
- Type 2 diabetes for relatives of the 1st and 2nd degree of kinship;
- age over 30 years;
- macrosomy (a child’s mass of more than 4 kg or more than 90 percentiles on a percental scale) of the fetus during a real pregnancy or in a history;
- fast and large increase in body weight during this pregnancy;
- glucoseuria during previous or real pregnancy;
- multi -guide during previous or real pregnancy;
- history of death;
- history of premature birth;
- the birth of children with congenital malformations in history;
- An inexplicable death of the newborn in history;
- taking glucocorticoids during pregnancy;
- pregnancy occurred as a result of the methods
- fertilization;
- multiple pregnancy;
- Violation of glucose tolerance before pregnancy.
With any type of diabetes mellitus, the goal is to achieve optimal glycemic control (table No. 3) by regular self -control of the level of glucose in the blood, conducting the food diary and the self -control diary, regular insulin therapy (in the presence of indications) and timely correction of treatment regimen.
Table 3. Targeted indicators of glycemic control at GDC.
The test indicator | Target level | |
Glucose, mmol/l (result calibrated in plasma/serum | On an empty stomach, before eating, before bedtime, at night at 03-00 | <5.1 |
1 hour after eating | ≤6.7 | |
Hypoglycemia | Absent | |
Ketone bodies in the urine | Absent | |
The risk factors of the uncontrolled course of GSD are the same as with other types of diabetes.
In case of GSD after delivery, insulin therapy is canceled, glycemia is monitored against the background of diet therapy with the advertising of the clinical diagnosis 4–12 weeks after childbirth; With manifestation, treatment correction is carried out.
Also, with GDC after childbirth, dynamic monitoring of the indicators of a woman’s carbohydrate exchange is carried out with a regular supervision of a general practitioner or endocrinologist if there are indications.
