WHAT ARE THE CONSEQUENCES OF GESTATIONAL DIABETES?

Gestational diabetes, also called 'gestational diabetes, occurs in pregnant women towards the end of the 2nd trimester. It can last the time of pregnancy or be indicative of previous diabetes. What are the symptoms and causes? What are the risks for the mother and the fetus? How are screening and diagnosis carried out? What are the treatments?

What is gestational diabetes?

According to the WHO definition, gestational diabetes is a disorder of carbohydrate tolerance leading to hyperglycemia of varying severity, onset or first diagnosis during pregnancy.

Under the term gestational diabetes, we group together two different populations: women who have unrecognized diabetes and that pregnancy will reveal women who develop diabetes only during pregnancy, a condition that most often goes away after pregnancy.

Causes of gestational diabetes.

As with diabetes, gestational diabetes is carbohydrate intolerance, that is, a disorder in the regulation of glucose (blood sugar) resulting in excess sugar in the blood or chronic hyperglycemia.

If there is an increased risk of diabetes during pregnancy, it is because pregnancy is inherently diabetogenic because it is physiological during this period a state of insulin resistance that will gradually worsen during pregnancy.
In all cases, gestational diabetes should be monitored and treated because it poses a risk to both mother and child.

Symptoms.

Gestational diabetes can go unnoticed, be asymptomatic (without symptoms) or present symptoms similar to those of other types of diabetes: intense thirst, frequent and abundant urination (urination), severe fatigue, etc.
Risks and complications of gestational diabetes
The risks for the mother and for the child are mainly in the perinatal period.

Risks for the child.

The excess glucose in the mother is passed on to the surplus fetus. This excess calorie reserve is stored in the child's organs. The weight and growth of the unborn child are then excessive. Macrosomia (birth weight over 4kg) can lead to difficult childbirth: shoulder dystocia can be life-threatening for the child. Other complications for the child are possible:
respiratory distress
neonatal hypoglycemia
risk of later developing type 2 diabetes

Risks to the mother.

the most serious complication is the occurrence of preeclampsia (or toxaemia of pregnancy) which may combine weight gain, oedema and high blood pressure.
cesarean delivery
risk of developing type 2 diabetes after pregnancy (7 times higher than without gestational diabetes)premature delivery.

Pregnant women at risk.

The risk factors for gestational diabetes are now well identified:
late pregnancy: in women over 35, the prevalence reaches 14.2%
the body mass index (BMI? 25kg / m²): in women with obesity and overweight, the prevalence reaches 19.1% and 11.1% respectively
a personal history of gestational diabetes: for women who have already developed gestational diabetes during a previous pregnancy, the prevalence rises to 50%
a family history of type 2 diabetes (parents, brother, sister)
a history of fetal macrosomia: birth weight of a baby over 4 kg.

Pregnant woman presenting no risk.

If the pregnant woman does not present at least one of these risk factors, we will only look for gestational diabetes in the event of hydramnios (too much amniotic fluid) or fetal biometrics (measurements of the size of the fetus. ) greater than or equal to the 97th percentile.
It should be noted that a young woman who is neither obese nor overweight and with a healthy lifestyle can develop gestational diabetes. This is a hormonal imbalance favored by certain factors and sometimes inevitable.

Diagnostic method to screen for gestational diabetes in women at risk.

For those with one of these risk factors, a first fasting blood sugar test in the first trimester (ideally before conception, as soon as you intend to have a child) is recommended to detect type 2 diabetes prior to pregnancy. and gone unnoticed so far. Then, a second test called OGPO (hyperglycemia caused by oral vision) is performed at 75g of glucose, between the 24th and 28th week of amenorrhea (absence of menstruation).
A single blood glucose value beyond the defined thresholds (0.92g / L on an empty stomach; or 1.80g / L 1 hour after oral glucose loading; or 1.53g / L 2 hours after) is sufficient to diagnose gestational diabetes. (The notion of sugar intolerance no longer exists, there is only "normal blood sugar" or gestational diabetes.)

Treatments for gestational diabetes.

The keys to successful treatment are based on a system that includes:

his blood glucose self-monitoring
hygiene and dietetic measures
a multidisciplinary team of doctors who monitor the patient's progress and her diabetes (general practitioner, gynaecologist, nutritionist, diabetologist, etc.).

Blood glucose self-monitoring and dietetic management.

Pregnant women should self-monitor blood sugar 4 to 6 times a day. Objective: keep blood sugar at an acceptable level, ie less than or equal to 0.95g / L on an empty stomach and less than 1.20g / L two hours after the start of the meal. These results determine the prescription of insulin treatment.

The first treatment is dietary management with an adapted diet and weight control:

low carbohydrate diet (favor foods with a low glycemic index that do little to raise blood sugar)
fractional meals: distribution of carbohydrate intake during the day (3 meals, 2 snacks)
calculation of the calorie intake adapted to each woman
favor fiber (they slow the absorption of carbohydrates and therefore the peak of post-meal hyperglycemia).

Physical activity.

Apart from medical contraindications, regular physical activity adapted to the profile of pregnant women is recommended in the case of temporary gestational diabetes or pregnancy with diabetes.

Insulin therapy.

Insulin is reserved for women for whom hygiene and dietetic measures are not sufficient to achieve glycemic balance. Oral antidiabetics are contraindicated for pregnant women. Rapid insulin injections of the “quick analogue” type may be prescribed, as well as slow insulin type NPH, if necessary.

Prevention of complications of gestational diabetes.

Are the complications of gestational diabetes preventable? The vast majority of gestational diabetes will not get complicated because it will respond very well to the combination of nutritional changes and appropriate physical activity.