No woman can be sure that her pregnancy will proceed without complications, especially if she suffers from any diseases. The fetus can be affected by various factors that can harm it. Therefore, it is extremely important to monitor your health and try to protect yourself from the influence of harmful conditions. Especially these points concern those women who have various disorders in the body.
Women diagnosed with diabetes mellitus and dreaming of having a baby should know that in this case they have a big responsibility, since such a disease can lead to various complications in the baby. One of them is fetopathy.
Features of the disease
Diabetic fetopathy is a serious fetal disease that occurs due to the presence of prediabetes or diabetes in a pregnant woman, when the glucose level exceeds normal levels. This pathology is characterized by a change in the state of the fetus and impaired functioning of his pancreas, kidneys, macro- and microvascular system.
If a pregnant woman has a diagnosis such as fetal fetopathy, then most often the doctor decides to perform an operative delivery.
The favorable course of pregnancy in a woman with diabetes depends on many factors. These include: the type of disease, existing complications, drugs taken to treat pathology. You can not be afraid of any harmful consequences, if throughout pregnancy the level of glycemia did not rise above a critical value.
If you do not compensate for this disease, then diabetes mellitus of pregnant women in the most negative way affects the development of the fetus and the gestation period. Doctors usually give birth to a woman in advance in order to save her and her child’s life. With such a disease, the ultrastructure of the placental barrier changes, as a result of which it ceases to function normally and deliver everything necessary to the fetus. Doctors in this case are often diagnosed with capillary hyperplasia. The child in utero gains a lot of weight, but at the same time develops poorly.
Signs
Diabetes mellitus during pregnancy leads to the fact that a newborn is born with the following signs of the disease:
- large body weight (usually more than 4 kg);
- pinpoint subcutaneous hemorrhage on the skin;
- puffiness of soft tissues and skin;
- large abdomen due to highly developed subcutaneous fat;
- short limbs;
- reddish-blue skin tone;
- excessive amount of cheese-like lubrication of the skin;
- broad shoulders.
Symptoms
Fetopathy of newborns is manifested as follows:
- respiratory distress, which is explained by the lack of synthesis of a specific substance in the lungs (surfactant), which helps them to straighten out with the first breath;
- shortness of breath and even respiratory arrest immediately after birth are likely;
- jaundice, considered a sign of a pathological change in the liver, which requires the necessary treatment;
- neurological disorders: decreased muscle tone, inhibition of the sucking reflex, alternation of decreased activity with hyper-excitability.
Causes
Fetopathy of a diabetic fetus develops due to an unfavorable course of pregnancy, during which uncompensated diabetes mellitus of types 1 and 2 arose. In addition, the cause is maternal diabetes.
Excessive glucose in the mother’s blood causes the fetal pancreas to start producing too much insulin. Entering through the blood of the mother to the child, glucose in large quantities begins to be actively consumed. However, for the full development of the fetus, a certain amount is required, so the excess is converted to fat, and this leads to a large weight of the child.
If glycemia is not normalized, this can contribute to a strong build-up of fetal fatty tissue and will not allow the entire internal system of organs and tissues of the baby to develop normally.
Diagnostics
To identify abnormalities in the fetus, the doctor prescribes the following procedures:
- Ultrasound
- study of the biophysical state of the fetus;
- dopplerometry;
- CTG;
- assessment of biochemical markers of the fetoplacental system.
Ultrasound
The main method for determining any abnormalities in the fetus is ultrasound. Ultrasound is recommended in the following periods if diabetes is diagnosed during pregnancy:
- In the first trimester - once.
- In the second trimester - also once between 24 and 26 weeks. This is necessary in order to identify various malformations of the central nervous, osteoarticular, genitourinary and cardiovascular system, as well as digestive organs.
- In the third trimester, an ultrasound scan can be performed two, or even three times. With insulin-dependent diabetes mellitus, such a study is carried out at 30-32 weeks, after which they are done once a week.
Signs of diabetic fetopathy by ultrasound of the fetus:
- too much weight for a specific period;
- imbalance of the body;
- double contour of the head;
- increased amount of water;
- dual fetal contour due to a large amount of subcutaneous fat or swelling of soft tissues;
- in the area of the bones of the skull, an echo-negative zone is noted, which indicates swelling.
Study of the biophysical state of the fetus
Such an examination can detect a violation in the morphofunctional development of the brain, which is considered the most severe manifestation of embryopathy. To find out, the doctor within one and a half hours fixes breathing, heart rate and motor activity of the fetus.
If there is a suspicion of fetopathy, then in this case the baby’s sleep will be short-lived, and most of the time he will make active movements. The duration of a short sleep is not more than 50 minutes, during which a slowdown in heart rate and a decrease in heart rate are noted.
Dopplerometry
With the help of such a study, the following indicators are monitored:
- myocardial fiber contraction rate;
- the value of cardiac output;
- the time of expulsion of the left ventricle of the heart;
- systolic-diastolic blood flow ratio in the artery.
Dopplerometry is performed at week 30 to assess the state of the central nervous system.
Cardiotocography with evaluation of functional tests
This procedure allows you to estimate the heart rate at rest, during movement, with uterine contractions. Doctors carry out tests and during this time take several samples.
Assessment of biochemical markers of the fetoplacental system
To diagnose fetoplacental insufficiency, urine and blood tests are taken. With this disease, in the third trimester, diabetic fetopathy is manifested by a significant increase in ACE.
Pregnancy treatment
Throughout pregnancy, a woman should conduct self-monitoring of blood pressure and glycemia. If this is required, then insulin therapy is additionally prescribed. For preventive purposes, sugar should be examined every 3-4 hours. The level of glycemia is corrected by glucose or insulin.
Diabetic fetopathy involves the intake of vitamins, adherence to a special diet and other doctor's recommendations. Food should be rich in easily digestible carbohydrates, and fatty is recommended to be reduced.
Delivery treatment
First, with the help of ultrasound, the optimal date of birth is determined. If the pregnancy is uncomplicated, then it is best to deliver the woman at 37 weeks. If there is a threat to the life of the mother and child, then do it at 36 weeks. Earlier medical abortion is usually carried out only if there is an immediate threat to the mother’s life and there is no question of saving the child.
Doctors are required to monitor glycemia during childbirth. With a strong decrease in blood sugar, a woman will not have enough strength during labor, since a lot of glucose is used to reduce the uterus. During or immediately after childbirth, there is a risk that the patient will fall into a hypoglycemic coma.
Pregnant diabetes mellitus involves a short birth. If they last more than 10 hours, then in this case they perform a cesarean section, after which antibiotic treatment is prescribed.
Postpartum treatment
To prevent the development of hypoglycemia and further complications, some time after birth, a 5% glucose solution is administered to the baby . Every 2 hours it is necessary to give breast milk to the newborn, as this nutrient fluid is able to stop this condition.
The early neonatal period should be under the supervision of doctors who are required to monitor the baby’s breathing. In its absence, an artificial lung ventilation apparatus is connected . In the presence of neurological disorders, calcium and magnesium solutions help. If the child has signs of liver disease, when the whites of the eyes and skin of the child acquire a jaundice, then the doctor prescribes sessions of ultraviolet radiation in a strictly defined dose.
After giving birth to a woman, the administration of insulin is reduced by a factor of 2–3 because the blood glucose level drops sharply. By the time of discharge, the glycemic rate is restored to normal values.
Complications
Diabetic fetopathy of newborns may have the following consequences:
- neonatal hypoxia;
- a sharp decrease in blood glucose to a critical level;
- acute heart failure;
- diabetes of the newborn;
- lack of magnesium and calcium, which negatively affects the functioning of the central nervous system;
- obesity.
Output
Diabetic fetopathy, which develops in the fetus with diabetes in his mother, is a very unpleasant and dangerous disease. During pregnancy, a woman must follow all the recommendations of a doctor and keep the blood glucose level under control. Only in this case, the consequences for the child will not be too deplorable.