Gestational diabetes mellitus impact on the child. Treatment of diabetes in pregnant women. A woman is prescribed only insulin medications

Gestational diabetes is expressed in insulin resistance (reduced sensitivity) of cells to insulin produced by the body against the background of hormonal shifts during pregnancy - the blocking effect is provided by lactogen, estrogen, cortisol and other substances that are extremely actively produced from the twentieth week after conception. However, not all women develop gestational diabetes mellitus - risk factors for developing the problem are:

1. Overweight. The basic factor in the development of type 2 diabetes can give rise to the formation of GDM during this difficult period for a woman’s body.
2. Age over thirty years. Late-parous women are at greater risk of developing gestational diabetes.
3. Impaired glucose resistance in a previous pregnancy. Pre-diabetes may appear again more clearly and unambiguously in the next pregnancy.
4. Genetic predisposition. If immediate family members were previously diagnosed with any type, the risk of developing GDM increases.
5. Polycystic ovary syndrome. As medical practice shows, women with this syndrome are more often diagnosed with gestational diabetes mellitus.
6. Bad obstetric history. Have you previously had chronic miscarriages, stillborn children, or children with physiological developmental defects? Previous births were difficult, the baby was very large or small, were other specific problems diagnosed (for example, polyhydramnios)? All this significantly increases the risk of developing GDM in the future.

Symptoms of Gestational Diabetes

GDM symptoms are most often associated with manifestations. In most cases, the patient does not feel at all external manifestations diseases, linking various ailments with a radical restructuring of the body and the processes of its adaptation to future childbirth, however, sometimes a pregnant woman may experience severe thirst and excessive consumption of liquids along with frequent urges for small needs, even if the fetus is still small. In addition, gestational diabetes mellitus is characterized by periodic increases in pressure, minor neurological manifestations (from frequent shifts mood to the point of hysterics), in rare cases, a woman is bothered by pain in the heart and numbness of the limbs.

As can be seen from the above, such symptoms quite often characterize the usual and associated classical pathologies (for example, toxicosis). A blurred “picture” does not allow one to unambiguously determine the problem, and in most cases, diabetes mellitus is diagnosed only with the help of appropriate tests.

Diagnostics

According to the standard monitoring scheme for patients, in the period from 22 to 28 weeks (it is then that the female body’s need for insulin increases significantly, on average up to 75 percent of the usual norm), a glucose tolerance test is performed. For this analysis, blood is first collected from a finger on an empty stomach in the morning. It should be noted that twelve hours before the test, you must refrain from eating, any medications not approved by the doctor, and also avoid physical/emotional stress, refrain from alcohol and smoking.

After collecting capillary blood according to the above scheme, the fair sex is given an oral dose of glucose equivalent to 75 grams, after which an hour and two hours later the second and third capillary blood sampling is done.

The norms of the above test are: on an empty stomach no more than 5.1 mmol/l, an hour after oral administration of glucose no more than 10 mmol/l, after 2 hours no more than 8.5 mmol/l. As a rule, fasting test values ​​in pregnant women with GDM are even lower than normal, but during exercise they are significantly higher.

Unlike classical and type 2, a test for glycated hemoglobin is not performed when gestational diabetes is suspected, since it is often false negative due to the peculiarities of the formation of temporary GDM in women.

In addition to this analysis, to confirm the diagnosis, the doctor must exclude other diseases that cause hyperglycemia, and, if necessary, prescribe alternative forms of research.

Due to certain risks for the future health of the baby, treatment of gestational diabetes mellitus is carried out as much as possible. safe methods With minimum set medicines. After GDM is detected, the fair sex will be prescribed special diet, as well as moderate physical loads that are feasible for her at this stage of fetal development. Now, up to 7 times a day, you will have to change the current blood sugar level using a glucometer and keep a detailed diary of test results, so that the doctor, if necessary, can familiarize himself with such statistics and adjust the course of therapy.

In some cases, diet and exercise are not enough - in this case, a specialist prescribes a course of insulin therapy for the period of pregnancy until childbirth. Specific dosages and dosage regimens for the drug are prescribed exclusively by your attending physician! Unfortunately, insulin injections do not provide maximum possible effect due to the poor sensitivity of tissue cells to this hormone in the case of gestational diabetes.

Another classic medication for lowering blood sugar levels is taking oral glucose-lowering medications. The vast majority of them are prohibited for use during pregnancy due to the very high risks to the health and life of the unborn child. An exception is metformin, but it is prescribed only in as a last resort after carefully weighing everything possible consequences and taking into account serious side effects.

The most effective mechanism for combating GDM is a properly selected diet - this is an axiom that has been relevant for more than five decades. Despite the similarity of symptoms and treatment methodology for gestational diabetes mellitus and type 1.2 diabetes mellitus, the nutritional systems for them differ significantly. If you have GDM, you should not use low-carb or vegan diets, as such eating patterns can negatively affect the future health of the pregnant fetus. Education is especially dangerous ketone bodies, after switching to feeding the body with its own fats. What to do? Doctors at this stage of a mother’s life, right up to childbirth, suggest switching to a rational, balanced diet. Its main points:

1. Fractional meals, 3 main approaches (breakfast, lunch, dinner) and 3 snacks.
2. Refusal to eat any products containing simple “fast” carbohydrates - flour, sweets, pickles, fast food and potatoes in any form.
3. Normal caloric intake is 35 kcal per kilogram of body weight.
4. The systemic distribution of BJU is 25–30 percent proteins, about 30 percent fats and up to 40–45 percent carbohydrates.
5. Be sure to consume foods with fiber to improve digestion and stabilize peristalsis.
6. Constant monitoring of sugar levels and ketone bodies, optimally after each meal (after 60 minutes).

With this diet, the optimal weight gain during pregnancy ranges from 11 to 16 kilograms. In general, the diet in women with GDM during the period from the beginning of pregnancy to childbirth is almost identical to the basic correct one. healthy eating representatives of the fair sex in interesting position without health problems, but requires stricter adherence to circadian rhythms and complete control of blood sugar/ketone levels.

Menu for the week

A classic weekly menu with six daily meals provides a pregnant woman with all the necessary elements, while helping to maintain normal carbohydrate metabolism and minimize the risks of complications of GDM.

Day 1

We have breakfast with a large sandwich with hard cheese and two tomatoes, as well as one boiled egg. For a snack before lunch - a small bowl of cottage cheese and a handful of raisins. We have vegetable soup for lunch. Having an afternoon snack with a large glass natural yogurt. We have dinner with a plate of vegetable salad and one avocado. Before going to bed, you can drink a glass of rosehip decoction.

Day 2

We have a plate of breakfast oatmeal, brewed with milk. We snack on two apples. We have lunch with chicken soup with meat. We have an afternoon snack with one hundred grams of low-fat cottage cheese. We have dinner with vegetable stew and a small piece of boiled beef. Before going to bed, we can drink a glass of one percent kefir without sugar.

Day 3

We have breakfast with a plate of omelet with two cucumbers. For second breakfast - a glass of yogurt. We have fish soup for lunch. We have an afternoon snack with two bananas. We have dinner with a plate of milk porridge. Before going to bed, we eat half a plate of vegetable salad.

Day 4

We have breakfast with cheesecakes interspersed with raisins and the addition of 15 percent natural sour cream. For a snack - a handful of peeled walnuts. We have lunch with a bowl of lentil soup. We have an afternoon snack with two small pears. We have dinner with a plate of steamed rice, baked chicken with tomatoes (100 grams). Before going to bed we drink tea.

Day 5

For breakfast we prepare an omelet with a sandwich ( butter, hard cheese, rye bread). Before lunch, drink a glass of tomato juice. We have lunch with vegetable stew and 100 grams of steamed meat. We have an afternoon snack with two peaches. For dinner - a plate of durum wheat spaghetti with tomato sauce. Before going to bed, you can drink a glass of herbal tea.

Day 6

We have breakfast with cottage cheese with the addition of grated berries. We have a snack with one small sandwich with a slice of hard cheese. We have lunch with a plate of buckwheat with stewed meat, vegetable salad And green tea. We have a glass of fresh juice in the afternoon. We have dinner with vegetable salad and 100 grams of chicken breast with tomatoes. Before going to bed, you can drink a glass of 1 percent milk.

Day 7

We have breakfast with a plate of milk corn porridge with dried apricots. We snack on two apples. Lunch is a classic tomato/cucumber salad and cabbage soup. We have an afternoon snack with a handful of dried fruits. We have dinner with zucchini pancakes with sour cream and a glass of juice. Before going to bed, you can drink a rosehip decoction.

We first of all recommend that all pregnant women diagnosed with gestational diabetes mellitus not panic - this syndrome, as global medical statistics show, is diagnosed annually in four percent of expectant mothers. Yes, this is an alarming “bell” that not everything is in order with the body, but in most cases, GDM disappears after childbirth. Naturally, for one and a half to two years after delivery, a woman should monitor the condition of the body, regularly donate blood for sugar and try to refrain from new pregnancy- the risks of recurrence of the disease and its transition to the main type 1 or 2 diabetes increase significantly.

Eat rationally and correctly, spend more time on fresh air, engage in dosed and doctor-recommended physical activity - the planned birth will go well and you will even be able to breastfeed your baby, carefully monitoring possible manifestations diabetes in the future.

Useful video

Gestational diabetes mellitus or pregnancy diabetes mellitus

Gestational diabetes mellitus in pregnant women

While many of us have heard about regular diabetes mellitus, few are familiar with what gestational diabetes mellitus is. Gestational diabetes is an increase in blood glucose (sugar) levels that was first detected during pregnancy.

The disease is not that common - only 4% of all pregnancies - but, just in case, you need to know about it, if only because this disease is far from harmless.

Diabetes mellitus during pregnancy can negatively affect the development of the fetus. If it arose on early stages pregnancy, the risk of miscarriage increases, and, even worse, the appearance of congenital malformations in the baby. Most often the most affected important organs crumbs - heart and brain.

Gestational diabetes onset in the second and third trimesters pregnancy, causes overfeeding and excessive growth of the fetus. This leads to hyperinsulinemia: after childbirth, when the baby no longer receives as much glucose from the mother, his blood sugar levels drop to very low levels.

If this disease is not identified and treated, it can lead to the development diabetic fetopathy- a complication in the fetus that develops due to a violation of carbohydrate metabolism in the mother’s body.

Signs of diabetic fetopathy in a child:

• large sizes (weight more than 4 kg);
• violation of body proportions (thin limbs, big belly);
• swelling of tissues, excess deposits of subcutaneous fat;
• jaundice;
• respiratory disorders;
• hypoglycemia of newborns, increased blood viscosity and the risk of blood clots, low levels of calcium and magnesium in the blood of the newborn.

How does gestational diabetes mellitus occur during pregnancy?

During pregnancy in female body there is not just a hormonal surge, but a whole hormonal storm, and one of the consequences of such changes is Impaired glucose tolerance– some are stronger, some are weaker. What does this mean? Blood sugar levels are high (above the upper limit of normal), but not high enough to warrant a diagnosis of diabetes.

In the third trimester of pregnancy, as a result of new hormonal changes, gestational diabetes may develop. The mechanism of its occurrence is as follows: the pancreas of pregnant women produces 3 times more insulin than other people - in order to compensate for the effect of specific hormones on the level of sugar contained in the blood.

If it does not cope with this function with increasing concentrations of hormones, then a phenomenon such as gestational diabetes mellitus occurs during pregnancy.

Risk group for developing gestational diabetes mellitus during pregnancy

There are certain risk factors that increase the likelihood that a woman will develop gestational diabetes during pregnancy. However, the presence of even all these factors does not guarantee that diabetes will still occur - just as the absence of these unfavorable factors does not guarantee 100% protection from this disease.

1. Excess body weight observed in a woman even before pregnancy (especially if the weight exceeded the norm by 20% or more);
2. Nationality. It turns out that there are certain ethnic groups in which gestational diabetes is much more common than in others. These include blacks, Hispanics, Native Americans and Asians;
3. High sugar level based on urine test results;
4. Impaired body tolerance to glucose (as we have already mentioned, the sugar level is higher than normal, but not so much as to make a diagnosis of diabetes);
5. Heredity. Diabetes is one of the most serious hereditary diseases, and your risk increases if someone close to you on your side was diabetic;
6. Previous birth of a large (over 4 kg) child;
7. Previous birth of a stillborn child;
8. You have already been diagnosed with gestational diabetes during previous pregnancy;
9. Polyhydramnios, that is, too much amniotic fluid.

Diagnosis of gestational diabetes mellitus

If you discover several signs that belong to a risk group, tell your doctor about this - you may be prescribed additional examination. If nothing wrong is found, you will undergo another test along with all the other women. All others pass screening examination for gestational diabetes between the 24th and 28th weeks of pregnancy.

How would this happen? You will be asked to do a test called an “oral glucose tolerance test.” You will need to drink a sweetened liquid containing 50 grams of sugar. In 20 minutes it will be less pleasant stage- taking blood from a vein. The fact is that this sugar is quickly absorbed, within 30-60 minutes, but individual indications vary, and this is what interests doctors. In this way, they find out how well the body is able to metabolize the sweet solution and absorb glucose.

If in the form in the “analysis results” column there is a figure of 140 mg/dl (7.7 mmol/l) or higher, this is already high level. You will be given another test, but this time after fasting for several hours.

Treatment of gestational diabetes mellitus

Life for diabetics, frankly speaking, is not sugar - both literally and figuratively. But this disease can also be controlled if you know how and strictly follow medical instructions.

So, what will help cope with gestational diabetes during pregnancy?

1. Controlling blood sugar levels. This is done 4 times a day - on an empty stomach and 2 hours after each meal. Additional checks may also be needed - before meals;
2. Urine tests. Ketone bodies should not appear in it - they indicate that diabetes is not controlled;
3. Follow a special diet that your doctor will tell you. We will consider this issue below;
4. Reasonable physical activity on the advice of a doctor;
5. Body weight control;
6. Insulin therapy as needed. On this moment During pregnancy, only insulin is allowed to be used as an antidiabetic drug;
7. Blood pressure control.

Diet for gestational diabetes mellitus

If you are diagnosed with gestational diabetes, you will have to reconsider your diet - this is one of the conditions for successful treatment of this disease. It is usually recommended to reduce body weight in diabetes (this contributes to increased insulin resistance), but pregnancy is not the time to lose weight, because the fetus must receive all the nutrients it needs. This means that you should reduce the calorie content of food without reducing its nutritional value.

1. Eat small meals 3 times a day and another 2-3 snacks at the same time. Don't skip meals! Breakfast should consist of 40-45% carbohydrates, the last evening snack should also contain carbohydrates, approximately 15-30 grams.

2. Avoid fried and fatty foods, as well as foods rich in easily digestible carbohydrates. These include, for example, confectionery, as well as baked goods and some fruits (banana, persimmon, grapes, cherries, figs). All these products are quickly absorbed and cause a rise in blood sugar levels; they contain few nutrients, but are high in calories. In addition, to neutralize their high glycemic effect, too much insulin is required, which is an unaffordable luxury for diabetes.

3. If you feel sick in the morning, keep a cracker or dry salty cookie on your bedside table and eat a few before getting out of bed. If you are being treated with insulin and feel sick in the morning, make sure you know how to deal with it. low level blood sugar.

4. Don't eat fast foods. They undergo industrial pre-processing to reduce their preparation time, but their effect on increasing the glycemic index is greater than that of their natural counterparts. Therefore, exclude from your diet freeze-dried noodles, “5-minute” soup from a bag, instant porridge, and freeze-dried mashed potatoes.

5. Pay attention to fiber-rich foods: cereals, rice, pasta, vegetables, fruits, whole grain bread. This is true not only for women with gestational diabetes– every pregnant woman should eat 20-35 grams of fiber per day. Why is fiber so good for diabetics? It stimulates the intestines and slows down the absorption of excess fat and sugar into the blood. Other fiber-rich foods contain a lot essential vitamins and minerals.

6. Saturated fat in the daily diet should not be more than 10%. And in general, eat less foods containing “hidden” and “visible” fats. Eliminate sausages, sausages, sausages, bacon, smoked meats, pork, and lamb. Lean meats are much preferable: turkey, beef, chicken, and fish. Remove all visible fat from meat: lard from meat, and skin from poultry. Prepare everything in a gentle way: boil, bake, steam.

7. Cook food without fat, and on vegetable oil, but there shouldn’t be too much of it.

8. Drink at least 1.5 liters of fluid per day(8 glasses).

9. Your body does not need such fats, like margarine, butter, mayonnaise, sour cream, nuts, seeds, cream cheese, sauces.

10. Tired of restrictions? There are also products that you can there is no limit– they are low in calories and carbohydrates. These are cucumbers, tomatoes, zucchini, mushrooms, radishes, zucchini, celery, lettuce, green beans, cabbage. Eat them in main meals or as snacks, preferably in the form of salads or boiled (boiled in the usual way or steamed).

11. Make sure your body is provided with the full range of vitamins and minerals needed during pregnancy: ask your doctor if you need additional dose vitamins and minerals.

If diet therapy does not help, and blood sugar remains at high level or at normal level sugar, ketone bodies are constantly detected in the urine - you will be prescribed insulin therapy.

Insulin is only injected because it is a protein, and if you try to put it into tablets, it will be completely destroyed by our digestive enzymes.

Disinfectants are added to insulin preparations, so do not wipe the skin with alcohol before injection - alcohol destroys insulin. Naturally, you need to use disposable syringes and observe personal hygiene rules. Your doctor will tell you all the other details of insulin therapy.

Exercise for gestational diabetes in pregnant women

Do you think it's not needed? On the contrary, they will help you maintain good health, maintain muscle tone, and recover faster after childbirth. In addition, they improve the action of insulin and help not gain excess weight. All this helps maintain optimal blood sugar levels.

Do your usual activities active work activities that you like and bring you pleasure: walking, gymnastics, exercises in the water. No stress on the stomach – you’ll have to forget about your favorite “abs” exercises for now. You should not engage in sports that are fraught with injuries and falls - horse riding, cycling, skating, skiing, etc.

All loads are based on how you feel! If you feel unwell or have pain in your lower abdomen or back, stop and catch your breath.

If you are on insulin therapy, it is important to be aware that hypoglycemia can occur during exercise, since both physical activity and insulin lower blood sugar levels. Check your blood sugar before and after exercise. If you started working out an hour after eating, you can eat a sandwich or an apple after class. If more than 2 hours have passed since your last meal, it is better to have a snack before training. Be sure to take juice or sugar with you in case of hypoglycemia.

Gestational diabetes and childbirth

The good news: after giving birth, gestational diabetes usually goes away - it develops into diabetes in only 20-25% of cases. True, the birth itself may be complicated due to this diagnosis. For example, due to the already mentioned overfeeding of the fetus, a child may be born very large.

Many might want a “hero,” but the large size of the child can be a problem during labor and childbirth: in most such cases, it is carried out, and in the case of natural delivery there is a risk of injury to the child’s shoulders.

For gestational diabetes children are born with reduced level blood sugar, but this can be corrected simply by feeding.

If there is no milk yet, and the child does not have enough colostrum, the child is fed with special formulas to raise the sugar level to normal value. Moreover, the medical staff constantly monitors this indicator, measuring glucose levels quite often, before feeding and 2 hours after.

As a rule, no special measures are needed to normalize the blood sugar level of the mother and child: in the child, as we have already said, sugar returns to normal thanks to feeding, and in the mother - with the release of the placenta, which is an “irritating factor”, since produces hormones.

The first time after giving birth to you I'll have to keep an eye on it monitor your diet and periodically measure your sugar levels, but over time everything should return to normal.

Prevention of gestational diabetes mellitus

There is no 100% guarantee that you will never encounter gestational diabetes - it happens that women who, by most indicators, fall into the risk group, do not get sick when they become pregnant, and vice versa, this disease happens to women who, it would seem, did not have no prerequisites.

If you already had gestational diabetes during a previous pregnancy, it is very likely to return. However, you can reduce your risk of developing gestational diabetes during pregnancy by maintaining a healthy weight and not gaining too much during those 9 months.

Physical activity will also help maintain your blood sugar at a safe level, provided that it is regular and does not cause you discomfort.

You also remain at risk of developing a permanent form of diabetes, type 2 diabetes. You will have to be more careful after childbirth. Therefore, it is not advisable for you to take drugs that increase insulin resistance: nicotinic acid, glucocorticoid drugs (these include, for example, dexamethasone and prednisolone).

Please note that some birth control pills may increase the risk of diabetes, such as progestins, but this does not apply to low-dose combination pills. When choosing a contraceptive after childbirth, follow your doctor's recommendations.

Replies

After pregnancy occurs, a woman is registered and undergoes many diagnostic procedures, including detecting blood and urine sugar levels. Approximately 4% of all pregnant women experience moderately elevated and persistent glucose levels. This condition is called gestational diabetes during pregnancy. If increased performance If detected and taken under the control of doctors on time, then nothing threatens the mother and child, and after childbirth this form of diabetes goes away on its own. Although this pathology is quite rare, it is better to take note of the features of this disease. Therefore, we will consider the causes, symptoms and treatment options for GDM.

The main trigger factor for gestational diabetes mellitus is pathological glucose tolerance. The cause of such disorders is overload of the pancreas. If in people outside of pregnancy such disruptions are caused by obesity and a sedentary lifestyle, then in pregnant women the nature of insulin resistance is completely different. The placenta actively secretes hormones with the opposite effect of insulin, thereby increasing the amount of glucose in the body. When certain factors are present in a woman, such as low physical activity or excessive weight gain, temporary diabetes appears. This occurs between 28 and 36 weeks of gestation.
Uncontrolled gestational diabetes can affect the overall course of pregnancy and even affect the poor development of embryonic organs. If the increase in sugar began in the first trimester, then the pregnancy will end in miscarriage or numerous congenital anomalies. The brain and cardiovascular system may be primarily affected.

On a note! Gestational diabetes mellitus during pregnancy affects development mental abilities and the usefulness of the formation of the nervous system only in the first trimester.

Insulin resistance in the 2nd and 3rd trimester provokes pathological feeding of the fetus and its intensive growth. The not yet formed pancreas begins to secrete a double dose of insulin to process all the sugar. But the baby needs a certain amount of glucose, and all the excess settles in the form of a fatty layer on the organs and under the skin. The baby’s internal organs—kidneys, liver, pancreas—begin to work harder, which will have a negative impact on health in the future. The fetus, receiving huge amounts of sugar from the mother (hyperinsulinemia), after birth begins to experience sugar hunger, and glucose levels begin to drop sharply. This condition is called diabetic fetopathy. This diagnosis can be made before the onset of labor using the results of an ultrasound examination. If it is confirmed, then an unplanned delivery is performed before the end of the gestation period.

Indirect signs of diabetic fetopathy:

1. Macrosomia (fetus over 4 kg).
2. Body disproportion (short limbs, abdominal circumference exceeds head volume for several weeks, broad shoulders, swelling of the face).
3. Cardiomegaly (underdeveloped and greatly enlarged liver and kidneys).
4. Breathing disorders and decreased fetal activity.
5. A large number of developmental anomalies.
6. Excess subcutaneous fat.

Important! Uncorrected diabetes can result in premature birth, severe trauma to the woman, and perinatal death.

Why is gestational diabetes mellitus dangerous during pregnancy?

• Polyhydramnios progresses.
• The risk of miscarriage doubles.
• Infections in the birth canal often worsen and are also transmitted to the baby.
• Ketone bodies are present in the blood, causing intoxication in the body of mother and child.
• A large fetus causes a caesarean section or severe trauma for a woman after childbirth.
• Disruption internal organs causes gestosis and fetal hypoxia.

Advice! A compensated amount of sugar during gestation eliminates the development of pathologies in the fetus and complications in the woman.

What causes gestational diabetes: determining the risk group

Even at the stage of pregnancy planning, a woman can independently or with the help of a therapist determine the likelihood of pathological glucose tolerance. Gestational diabetes mellitus during pregnancy occurs most often against the background of a history of the following diseases:

1. Excess weight (advanced forms of obesity).
2. Pregnancy planning for the age category 30+.
3. Stable weight gain after 18 years and until pregnancy.
4. Patients with diabetes mellitus along the ancestral line.
5. Hormonal imbalance (polycystic ovary syndrome).
6. Prediabetic state (slight increase in sugar above normal).
7. Endocrine disorders.
8. Previous pregnancy with gestational diabetes.
9. The first child was born weighing more than 4 kg.

Interesting! The chances of developing gestational diabetes are significantly higher in some ethnic groups, namely Hispanic, Native American and Asian women.

Diagnosis of gestational diabetes: symptoms and laboratory values

Laboratory diagnostics to detect latent gestational diabetes are mandatory for all women in an “interesting” position between 24 and 28 weeks of gestation. This form of diabetes manifests itself in the same way as other types, but in most cases there are no symptoms at all. How to suspect the development of GDM before a planned study:

• The woman begins to experience a constant desire to drink.
• Frequent urination appears.
• Appetite is disrupted (you want to eat all the time or, conversely, you cannot eat anything).
• Blood pressure rises.
• Severe fatigue is noted.
• There is cloudiness in the eyes.

The symptoms are quite superficial and can be present without an increase in glucose, but the presence of at least a few of them should be the reason for a visit to the gynecologist to clarify their nature.

Gestational diabetes is determined by a test called an oral glucose tolerance test. To get reliable test results, you need to properly prepare for donating blood. The material is collected first only on an empty stomach, then after taking 50 g of glucose (orally) after 1 hour and then after another 2 hours. The results obtained show how well the body copes with the received glucose.

Standard sugar levels:

• 1st blood draw - 5.49 mmol/l;
• 2nd sampling - 11.09 mmol/l;
• 3rd sampling - 7.79 mmol/l.

Gestational diabetes mellitus during pregnancy is confirmed by the following indicators:

• 1st sampling - 5.49-6.69 mmol/l;
• 2nd sampling - less than 11.09 mmol/l;
• 3rd sampling - more than 11.09 mmol/l.

A primary increase in sugar should not frighten a woman expecting a baby, since the endocrinologist will refer her for re-diagnosis in 10-12 days. The fact is that the following factors can influence the result:

1. Eating large amounts of sugar-containing foods on the eve of diagnosis.
2. Experienced stress or anxiety.
3. Eating less than 8 hours before blood collection.
4. Low or, on the contrary, strong physical activity.

A one-time rise in glucose is not a reason to panic. There is always a risk of error and non-compliance with blood donation rules. Only a twice confirmed increase in values ​​can confirm the presence of diabetes.

Principles of treatment of GDM in pregnant women

Since gestational diabetes during pregnancy affects the fetus, it is necessary correct treatment women before childbirth, and sometimes after them. The essence of therapy comes down to eliminating unfavorable factors that affect blood sugar levels and constant monitoring of its amount. Regular checks on the condition of the fetus are also carried out.

1. Continuous monitoring of glucose levels. At least 4-6 times a day: on an empty stomach, 1.5 hours after a meal, sometimes you need to check your sugar before eating.
2. Regular determination of ketone bodies in morning urine. Their presence indicates uncompensated diabetes.
3. A strictly balanced diet.
4. Individually selected physical activity taking into account the condition of the pregnant woman.
5. Maintaining optimal body weight (calculated individually based on body mass index).
6. Monitoring blood pressure indicators.
7. In severe forms of GDM, insulin therapy is indicated. Sugar-lowering tablets are not prescribed.

Gestational diabetes mellitus during pregnancy: diet and daily routine

The primary cure for gestational diabetes during pregnancy is diet. Because losing weight is not the most suitable way treatment for pregnant women, you need to eat right. The menu for diabetes is compiled so that it is as nutritious as possible, and at the same time low in calories.

Drawing up a rational menu

• Control your carbs. The amount of carbohydrates should be less than 45% of the total caloric intake of the daily diet. It is preferable to eat foods that contain a lot of fiber (whole grain cereals, legumes). Instead of eating starchy foods (bread, potatoes, cookies, spaghetti), it is better to replenish carbohydrate reserves with vegetables (carrots, broccoli).
• Eat in small portions of 200-250 g. You need to eat in small portions 5-6 times a day. Add a small portion of salad or fresh vegetable juice to each meal. Choose green and yellow types of vegetables (pumpkin, carrots, lettuce, spinach, bell peppers, zucchini).
• Avoid fried foods that are high in fat. Eat boiled or baked foods without spicy or fatty sauces. Also avoid foods with a high glycemic index (baked goods, confectionery, regular wheat pasta, sweet fruits).
• Tame morning sickness with crackers and biscuits while eating breakfast in bed.
• Don't buy fast food products. This category of products, in addition to a mountain of preservatives, contains fast carbohydrates. Therefore, introduce a taboo in your kitchen for instant noodles and freeze-dried mashed potatoes.
• The amount of saturated fat should not exceed 10%. Cook only lean types of meat: poultry, rabbit, beef, lean pork, fish. Remove any available fat layers and remove the skin from the bird.
• Drink 1.5 l clean water per day if there are no contraindications.

Such products are strictly prohibited: margarine, spread, mayonnaise, sour cream, cream, butter, nuts and seeds (limited), sauces, sweet carbonated drinks, sweetened juices.

Allowed without restrictions: cucumbers, ginger, zucchini, radishes, beans, lettuce, zucchini, all kinds of mushrooms, all leafy vegetables, cabbage, tomatoes, citrus fruits.

Advice! In winter, to prevent vitamin deficiency, pregnant women are prescribed additional vitamin complexes.

Diabetes and exercise

Moderate exercise also helps keep sugar levels under control. To maintain weight, muscle tone and wellness You can attend yoga classes or fitness classes for pregnant women, or you can simply do light exercises at home. Naturally, there can be no talk of doing abdominal exercises, cycling or jumping rope. All classes should be carried out only at will and in excellent health. If you didn't exercise before pregnancy, swimming, walking or running are fine. The optimal physical education regimen involves 20-minute sessions three times a week.

On a note! If you are on insulin therapy, you should check your sugar levels before and after exercise. Physical activity helps lower sugar. Therefore, temporary hypoglycemia may occur.

Physical exercise for pregnant women helps keep your weight within normal limits. If a woman did not suffer from extra pounds before pregnancy, then gaining 10-16 kg over the entire gestation period is considered acceptable. In case of obvious obesity, weight gain is limited to 7 kg.

Gestational diabetes: course of labor and postpartum control

During labor activity Glucose levels are monitored every 2-3 hours. If the level rises to a critical level, insulin is administered, and if it falls, glucose is administered. The fetal heartbeat and breathing rhythm are also monitored. In case of complications, an emergency caesarean section is performed.
The baby's glucose level is determined after birth. The excess insulin produced does not immediately return to normal, so the baby has a reduced amount of sugar. To stabilize the child's condition, he is given a glucose solution intravenously.
Gestational diabetes indicates a woman's predisposition to type 2 diabetes. After birth, glucose levels drop to normal indicators in a few hours, but it is recommended to check its amount after 6 weeks, and then every 3 months.

It is impossible to completely exclude the possibility of gestational diabetes in pregnant women. So if you're in the zone increased risk development of insulin resistance, immediately report this to your doctor and eliminate all provoking factors of this disease. Remember that GDM is not a death sentence and, if the recommendations are followed, does not affect pregnancy.

Gestational diabetes mellitus in pregnant women. Video

In some cases, pregnant women develop gestational diabetes mellitus (GDM). This form of the disease can appear exclusively during pregnancy and disappear some time after childbirth. But if timely treatment is not carried out, the disease can develop into type 2 diabetes, which has complex consequences.

When pregnancy occurs, every woman must register, where, under the supervision of specialists, her well-being will be monitored expectant mother and fetal development.

Every pregnant woman should regularly monitor her sugar by taking urine and blood tests. Isolated cases of increased glucose levels in tests should not cause panic, since such jumps are considered a normal physiological process. But, if, when taking tests, elevated sugar is noticed in two or more cases, then this already signals the presence of gestational diabetes mellitus during pregnancy. It is noteworthy that an increased level is detected when the material is taken on an empty stomach (an increase in blood sugar levels after eating is the norm).

Causes of pathology

The risk group includes women to whom the following parameters can be applied:

• overweight or obesity;
• if previous births occurred with gestational diabetes;
• hereditary factor (transmitted genetically);
• ovarian pathologies (polycystic disease);
• pregnancy after 30 years of age.

According to statistics, complications during childbearing occur in 10% of women. The cause of gestational diabetes can be called, as with type 2 diabetes, loss of cell sensitivity to insulin. It is noted high rate blood glucose levels due to high concentrations of pregnancy hormones.

Insulin resistance most often appears between 28 and 38 weeks of pregnancy, and is accompanied by weight gain. It is believed that a decrease in physical activity during this period also affects the appearance of GDM.

Symptoms

Symptoms of GDM are not much different from the symptoms of type 2 diabetes:

• a constant feeling of thirst, while drinking does not bring relief;
• frequent urination, causing discomfort;
• There may be a decrease in appetite or a feeling of constant hunger;
• jumps in blood pressure appear;
• vision suffers, blurred vision appears.

Diagnostics

If at least one of the above signs is present, then a mandatory visit to the gynecologist and testing for sugar levels is required. This analysis is called a glucose tolerance test (GTT). The test helps determine the digestibility of glucose by the cells of a pregnant woman’s body and possible violations this process.

To conduct the test, venous blood is taken from the patient (on an empty stomach). If the result shows elevated sugar levels, a diagnosis of gestational diabetes is made. If the indicators are underestimated, GTT is carried out. To do this, glucose in the amount of 75 g is diluted in a glass (250 ml) of slightly warmed water and given to the woman to drink. An hour later, blood is taken again from a vein. If the indicators are normal, then for control the test can be repeated after 2 hours.

Danger of GDM for the fetus

What are the risks of histosis diabetes? developing fetus? Since this pathology does not pose a direct danger to the life of the expectant mother, but can only be dangerous for the baby, treatment is aimed at preventing perinatal complications, as well as complications during childbirth.

The consequences for a child with gestational diabetes are expressed in its negative impact on blood microcirculation in the tissues of the pregnant woman. All complex processes caused by impaired microcirculation ultimately lead to hypoxic effects on the fetus.

Also, the supply of large amounts of glucose to the baby cannot be called harmless. After all, insulin produced by the mother cannot penetrate the placental barrier, and the baby’s pancreas is not yet able to produce required amount hormone.

As a result of the influence of diabetes mellitus, the metabolic processes in the fetus are disrupted, and it begins to gain weight due to the growth of adipose tissue. Next, the baby experiences the following changes:

• an increase in the shoulder girdle is noticed;
• the stomach increases significantly;
• the liver and heart increase in size;

All these changes take place against the background of the fact that the head and limbs remain the same (normal) sizes. All this can affect the development of the situation in the future, and cause the following consequences:

• due to the increase in the fetal shoulder girdle, it becomes difficult to pass through the birth canal during childbirth;
• During childbirth, injuries to the baby and the mother’s organs are possible;
• premature birth may begin due to the large mass of the fetus, which has not yet fully developed;
• in the lungs of a baby in the womb, the production of surfactant, which prevents them from sticking together, decreases. As a result, after birth the baby may have breathing problems. In this case, the child is rescued using an artificial respiration apparatus, and then placed in a special incubator (incubator), where he will remain for some time under the close supervision of doctors.

Also, one cannot fail to mention the consequences of why gestational diabetes mellitus is dangerous: children born from a mother with GDM may have congenital organ defects, and some may develop second-degree diabetes in adulthood.

The placenta also tends to enlarge during GDM, begins to perform its functions insufficiently, and may become edematous. As a result, the fetus does not receive the required amount of oxygen and hypoxia occurs. Namely, at the end of pregnancy (third trimester) there is a danger of fetal death.

Treatment

Since the disease is caused by high sugar levels, it is logical to assume that for the treatment and prevention of pathology it is necessary to control that this indicator is within the normal range.

The main factor influencing the course of diabetes treatment during pregnancy is strict adherence to dietary rules:

• Baked goods and confectionery products are excluded from the diet, which can affect the increase in sugar levels. But you shouldn’t completely give up carbohydrates, because they serve as a source of energy. It is only necessary to limit their number throughout the day;
• limit the consumption of very sweet fruits high in carbohydrates;
• exclude noodles, purees and instant cereals, as well as various semi-finished products;
• remove smoked meats and fats from the diet (butter, margarine, mayonnaise, lard);
• It is necessary to eat protein foods, it is important for the body of mother and child;
• for cooking, it is recommended to use: stewing, boiling, steaming, baking in the oven;
• You should eat food every 3 hours, but in small portions.

Moreover, it has been proven positive influence on the health of the expectant mother:

• complex physical exercise, designed for pregnant women. During physical activity, the concentration of sugar in the blood decreases, improvement metabolic processes in the body and general well-being of the pregnant woman;
• regular walks away from highways.

At severe course diseases, your doctor may prescribe insulin medications. Other medications that lower sugar are prohibited.

1. B - category. It includes products whose description says that in animal studies, harmful effects no effect was observed on the fetus. The effect of the drug on pregnancy has not been tested.
2. C - category. Includes drugs that have been tested to have an effect on fetal development in animals. Tests have not been conducted in pregnant women either.

Therefore, all drugs must be prescribed only by a qualified doctor, with the mandatory indication of the trade name of the drug.

Hospitalization for GDM is relevant only if there is a suspicion of complex obstetric complications.

GDM is not a reason to stimulate premature birth or a caesarean section.

Postpartum period

After childbirth, a woman should regularly check her sugar level, monitor the presence of symptoms and their frequency (thirst, urination, etc.) until they disappear completely. Testing is usually prescribed by doctors 6 and 12 weeks after birth. By this time, the woman’s blood sugar level should normalize.

But, according to statistics, in 5-10% of women who give birth, sugar levels do not normalize. In this case it is required medical assistance, which should not be neglected, otherwise a simple hormonal disorder can develop into a serious incurable disease.

Gestational diabetes mellitus (GDM): the danger of a “sweet” pregnancy. Consequences for the child, diet, signs

According to World Organization There are more than 422 million people with diabetes in the world. Their number is growing every year. The disease is increasingly affecting young people.

Complications of diabetes lead to serious vascular pathologies, affecting the kidneys, retina, etc. But this disease is controllable. With properly prescribed therapy severe consequences move away in time. No exception pregnancy diabetes, which developed during gestation. This disease is called gestational diabetes mellitus.

• Can pregnancy cause diabetes?
• What are the types of diabetes during pregnancy?
• Risk group
• What is gestational diabetes mellitus during pregnancy?
• Consequences for the child
• What is the danger for a woman?
• Symptoms and signs of gestational diabetes mellitus in pregnant women
• Analyzes and deadlines
• Treatment
• Insulin therapy: who is indicated and how it is carried out
• Diet: allowed and prohibited foods, basic principles of nutrition for pregnant women with GDM
• Sample menu for the week
• ethnoscience
• How to give birth: natural birth or caesarean section?
• Prevention of gestational diabetes in pregnant women

Is pregnancy a provocateur?

The American Diabetes Association reports that 7% of pregnant women develop gestational diabetes. In some of them, after childbirth, glucose levels return to normal. But 60% will develop type 2 diabetes (T2DM) within 10-15 years.

Gestation acts as a provocateur for impaired glucose metabolism. The mechanism of development of the gestational form of diabetes is closer to T2DM. A pregnant woman develops insulin resistance due to the following factors:

• synthesis of steroid hormones in the placenta: estrogen, placental lactogen;
• increased production of cortisol in the adrenal cortex;
• disruption of insulin metabolism and reduction of its effects in tissues;
• increased excretion of insulin through the kidneys;
• activation of insulinase in the placenta (an enzyme that breaks down hormones).

The condition worsens in those women who have physiological resistance (immunity) to insulin, which has not manifested itself clinically. The listed factors increase the need for the hormone; beta cells of the pancreas synthesize it in increased quantity. This gradually leads to their depletion and persistent hyperglycemia - an increase in the level of glucose in the blood plasma.

What types of diabetes are there during pregnancy?

Pregnancy may be accompanied by different types diabetes Classification of pathology by time of occurrence involves two forms:

1. diabetes that existed before pregnancy (DM 1 and DM 2) – pregestational;
2. gestational diabetes (GDM) in pregnant women.

Depending on the required treatment for GDM, there are:

• compensated by diet;
• compensated by diet therapy and insulin.

Diabetes can be in the stages of compensation and decompensation. The severity of pregestational diabetes depends on the need to use various methods treatment and severity of complications.

Hyperglycemia that develops during pregnancy is not always gestational diabetes. In some cases, this may be a manifestation of type 2 diabetes.

Who is at risk for developing diabetes during pregnancy?

Hormonal changes that can disrupt the metabolism of insulin and glucose occur in all pregnant women. But the transition to diabetes does not happen for everyone. This requires predisposing factors:

• overweight or obesity;
• existing impaired glucose tolerance;
• episodes of high blood sugar before pregnancy;
• Type 2 diabetes in the parents of a pregnant woman;
• age over 35 years;
• history of miscarriages, stillbirths;
• previous birth of children weighing more than 4 kg, as well as with developmental defects.

But which of these reasons influences the development of pathology to a greater extent is not completely known.

What is gestational diabetes mellitus

GDM is considered to be the pathology that developed after bearing a child. If hyperglycemia is diagnosed earlier, then latent diabetes mellitus exists, which existed before pregnancy. But the peak incidence is observed in the 3rd trimester. A synonym for this condition is gestational diabetes.

Manifest diabetes during pregnancy differs from gestational diabetes in that after one episode of hyperglycemia, sugar gradually increases and does not tend to stabilize. This form of the disease is likely to develop into type 1 or type 2 diabetes after childbirth.

To decide on further tactics, all postpartum women with GDM should postpartum period determine glucose levels. If it does not return to normal, then we can assume that type 1 or type 2 diabetes has developed.

Effect on the fetus and consequences for the child

The danger for the developing child depends on the degree of compensation of the pathology. The most severe consequences are observed in the uncompensated form. The effect on the fetus is as follows:

1. Fetal malformations with elevated glucose levels in the early stages. Their formation occurs due to energy deficiency. In the early stages, the baby's pancreas is not yet formed, so the maternal organ must work for two. Malfunction leads to energy starvation of cells, disruption of their division and the formation of defects. This condition can be suspected by the presence of polyhydramnios. Insufficient supply of glucose into cells is manifested by a delay intrauterine development, low birth weight baby.
2. Uncontrolled sugar levels in a pregnant woman with gestational diabetes mellitus in the 2nd and 3rd trimester leads to diabetic fetopathy. Glucose penetrates the placenta in unlimited quantities, the excess is stored as fat. If your own insulin is in excess, it occurs accelerated growth fetus, but there is a disproportion of body parts: large belly, shoulder girdle, small limbs. The heart and liver also enlarge.
3. A high concentration of insulin disrupts the production of surfactant, a substance that coats the alveoli of the lungs. Therefore, respiratory distress may occur after birth.
4. Tying the umbilical cord of a newborn disrupts the supply of excess glucose, and the child's glucose concentration sharply decreases. Hypoglycemia after childbirth leads to neurological disorders and mental development disorders.

Also, children born to mothers with gestational diabetes have an increased risk birth trauma, perinatal death, cardiovascular diseases, pathologies of the respiratory system, calcium and magnesium metabolism disorders, neurological complications.

Why high sugar is dangerous for a pregnant woman

GDM or pre-existing diabetes increases the possibility of late toxicosis (), it manifests itself in various forms:

• dropsy of pregnancy;
• nephropathy grade 1-3;
• preeclampsia;
• eclampsia.

The last two conditions require hospitalization in the intensive care unit, resuscitation measures and early delivery.

Immune disorders that accompany diabetes lead to infections of the genitourinary system - cystitis, pyelonephritis, as well as recurrent vulovaginal candidiasis. Any infection can lead to infection of the child in utero or during childbirth.

The main signs of gestational diabetes mellitus during pregnancy

Symptoms of gestational diabetes are not pronounced, the disease develops gradually. Women mistake some signs for normal changes during pregnancy:

• increased fatigue, weakness;
• thirst;
• frequent urination;
• insufficient weight gain with pronounced appetite.

Often hyperglycemia is an incidental finding during a mandatory blood glucose screening test. This serves as an indication for further in-depth examination.

Basis for diagnosis, tests for latent diabetes

The Ministry of Health has determined the time frame within which a mandatory blood sugar test is carried out:

• upon registration;

If there are risk factors, a glucose tolerance test is performed. If symptoms of diabetes appear during pregnancy, a glucose test is performed as indicated.

A single test that reveals hyperglycemia is not enough to make a diagnosis. Monitoring is required after a few days. Further, in case of repeated hyperglycemia, a consultation with an endocrinologist is prescribed. The doctor determines the need and timing of a glucose tolerance test. Usually this is at least 1 week after recorded hyperglycemia. The test is also repeated to confirm the diagnosis.

They talk about GDM following results test:

• fasting glucose value more than 5.8 mmol/l;
• an hour after taking glucose – above 10 mmol/l;
• after two hours – above 8 mmol/l.

Additionally, according to indications, the following studies are carried out:

• glycosylated hemoglobin;
• urine test for sugar;
• cholesterol and lipid profile;
• coagulogram;
• blood hormones: estrogen, placental lactogen, cortisol, alpha-fetoprotein;
• urine analysis according to Nechiporenko, Zimnitsky, Rehberg test.

Pregnant women with pregestational and gestational diabetes undergo fetal ultrasound from the 2nd trimester, Dopplerometry of the vessels of the placenta and umbilical cord, and regular CTG.

Management and treatment of pregnant women with diabetes mellitus

The course of pregnancy with existing diabetes depends on the woman’s level of self-control and correction of hyperglycemia. Those who had diabetes before conception must go through the “Diabetes School” - special classes that teach the correct eating behavior, self-monitoring of glucose levels.

Regardless of the type of pathology, pregnant women need the following observations:

• visiting a gynecologist every 2 weeks at the beginning of gestation, weekly from the second half;
• consultations with an endocrinologist once every 2 weeks, in case of decompensated condition – once a week;
• observation by a therapist - every trimester, as well as when extragenetic pathology is detected;
• ophthalmologist - once every trimester and after childbirth;
• neurologist - twice during pregnancy.

Mandatory hospitalization is provided for examination and correction of therapy for a pregnant woman with GDM:

• 1 time – in the first trimester or when pathology is diagnosed;
• 2 times - in - to correct the condition, determine the need to change the treatment regimen;
• 3 times - for type 1 and type 2 diabetes - in, GDM - in to prepare for childbirth and select the method of delivery.

In a hospital setting, the frequency of studies, the list of tests and the frequency of studies are determined individually. Daily monitoring requires a urine test for sugar, blood glucose, and blood pressure control.

Insulin

The need for insulin injections is determined individually. Not every case of GDM requires this approach; for some, a therapeutic diet is sufficient.

Indications for starting insulin therapy are the following blood sugar levels:

• fasting blood glucose on a diet more than 5.0 mmol/l;
• one hour after eating above 7.8 mmol/l;
• 2 hours after eating, glycemia is above 6.7 mmol/l.

Attention! Pregnant and lactating women are prohibited from using any glucose-lowering drugs except insulin! Long-acting insulins are not used.

The basis of therapy is short- and ultra-short-acting insulin preparations. For type 1 diabetes, basal-bolus therapy is carried out. For type 2 diabetes and GDM, it is also possible to use the traditional regimen, but with some individual adjustments, which are determined by the endocrinologist.

In pregnant women with poor hypoglycemia control, insulin pumps may be used to make the hormone easier to administer.

Diet for gestational diabetes during pregnancy

The nutrition of a pregnant woman with GDM should comply with the following principles:

• Often and little by little. It is better to have 3 main meals and 2-3 small snacks.
• The amount of complex carbohydrates is about 40%, protein – 30-60%, fats up to 30%.
• Drink at least 1.5 liters of liquid.
• Increase the amount of fiber - it is able to adsorb glucose from the intestines and remove it.

Current video

Diet for gestational diabetes mellitus in pregnant women

Products can be divided into three conditional groups, presented in Table 1.

Table 1

Sample menu for a pregnant woman with gestational diabetes

The menu for the week (Table 2) may look approximately as follows (table No. 9).

Table 2.

ethnoscience

Methods traditional medicine offer many recipes on how to use herbal remedies to lower blood sugar and replace sugary foods. For example, stevia and its extracts are used as a sweetener.

This plant is not dangerous for diabetics, but use in pregnant and lactating women is not recommended. No studies have been conducted on the effect on the course of pregnancy and fetal formation. In addition, the plant can cause an allergic reaction, which is extremely undesirable during pregnancy against the background of gestational diabetes.

Natural birth or caesarean?

How delivery will take place depends on the condition of the mother and child. Hospitalization of pregnant women with gestational diabetes mellitus is carried out in -. To avoid birth trauma, they try to induce labor with a full-term baby at this time.

If the woman’s condition is serious or the fetus is pathological, the issue of performing a caesarean section is decided. If the results of an ultrasound determine a large fetus, the correspondence of the size of the woman’s pelvis and the possibility of childbirth are determined.

At sharp deterioration condition of the fetus, the development of severe gestosis, retinopathy and nephropathy of the pregnant woman, a decision may be made about early birth.

Prevention methods

It is not always possible to avoid the disease, but you can reduce the risk of its occurrence. Women who are overweight or obese should start planning pregnancy with diet and weight loss.

Everyone else should adhere to the principles of a healthy diet, control weight gain, reduce the consumption of sweets and starchy foods, fatty foods. We must not forget about sufficient physical activity. Pregnancy is not a disease. Therefore, during its normal course, it is recommended to perform special sets of exercises.

Women with hyperglycemia should take into account the doctor's recommendations and be hospitalized in deadlines for examination and treatment correction. This will prevent the development of complications of gestational diabetes mellitus. For those who had GDM in a previous pregnancy, the risk of developing diabetes is significantly increased with a second pregnancy.