Pregnancy

Gestational diabetes: what are the risks for mother and child?

Diabète gestationnel : quels risques pour la mère et l

Gestational diabetes should not be overlooked because of the complications it can cause, both for the mother and for her baby. Fortunately, it is easy to treat, especially thanks to an adapted diet. What there is to know.

Gestational diabetes is defined as an abnormality in glucose tolerance leading to hyperglycemia of varying severity, the diagnosis of which is made during pregnancy. In 85% of cases, diabetes is due to an abnormality in glycemic tolerance, which appears in the second half of pregnancy, that is between the 22nd and the 24th week. “However, it must be understood that it is not because a pregnant woman has hyperglycemia that it did not exist before pregnancy“, specifies Pr Jacques Lepercq, obstetrician gynecologist at the Saint Vincent de Paul hospital in Paris. In fact, in 15% of cases, gestational diabetes diagnosis only reveals a Type 2 diabetes, already present before pregnancy, but not detected. Remember that type 2 diabetes (unlike type 1 diabetes) does not cause any symptoms and that only a blood test (measurement of blood sugar) can reveal it.

During the second trimester of pregnancy, more specifically between the 22nd and the 24th week of pregnancy, the placenta begins to produce many hormones whose role is to promote the passage of all the elements necessary for the growth of the fetus (nutrients, oxygen, energy …). Objective: to make it grow and gain weight. “It is the period of our life when growth is fastest and strongest. And for good reason: the future baby will go from a weight of around 500 g to 3 kg at birth, a weight multiplied by 10 in just 3 months! “, specifies Professor Lepercq. These placental hormones also have the effect of reducing the effectiveness of insulin, whose role is to regulate the blood sugar level. Hopefully, this insulin resistance causes the pancreas to produce more to compensate for and maintain normal blood sugar levels. Only, as Jacques Lepercq explains, “when the pancreas is not efficient enough or the pregnant woman is overweight, she cannot adapt her production of insulin, causing hyperglycemia and therefore gestational diabetes “.

  • Overweight and obesity: an overweight woman with a BMI greater than 25 is at risk of gestational diabetes.
  • A age over 35
  • The family history in the first degree of type 2 diabetes (in parents or among siblings).
  • The history of gestational diabetes or giving birth to a “big baby” (over 4 kg at term).
  • Finding a high blood sugar level under the pill.
  • Birth weight: a mother’s birth weight greater than 4 kg or less than 2.5 kg.
  • History of miscarriages, fetal malformations or death of the fetus. History of fetal macrosomia (measurements of the fetus above the curves of the cranial and abdominal perimeter) during a previous pregnancy.
  • Gestational diabetes in a previous pregnancy.
  • Childbirth babies over 4 kg.
  • Geographical origins : women from Asia, North Africa or the West Indies.

Today, there is a trend towardsincreased prevalence of gestational diabetes. The reason ? “The increase in overweight and obesity, as well as inactivity, clearly contribute to this development. Overweight is THE number 1 risk factor for gestational diabetes “, insists Jacques Lepercq. Remember also that gestational diabetes appears in the absence of a risk factor in more than half of the cases.

If you have too much blood sugar, it crosses the placenta and the fetus then produces more insulin, which leads to excessive growth, especially of adipose tissue. He can therefore gain weight quickly, which is not without problems when giving birth (increased risk of cesarean especially). In addition, complications are possible for the mother, especially hypertension. “Overweight or obese women are already by definition more likely to give birth by cesarean section and to have hypertension. The risk is therefore even greater in the case of diabetes in these people“, warns Professor Jacques Lepercq. In addition, in the mother, there is a increased post natal diabetes with a risk multiplied by 7! “This is the reason why the management of diabetes does not stop at childbirth. Postpartum, mothers should continue to eat well and have their blood sugar checked every year “, adds Professor Anne Vambergue, diabetologist at Claude Huriez hospital in Lille *.

Gestational diabetes, that touches 8% of pregnancies, can be the cause of complications in the mother and her child at birth, according to a national led by the National Fund of the Health Insurance of salaried workers (Cnamts) and teams of the Public Assistance-Hospitals of Paris . The study published in the journal Diabetologia on February 16, 2017 relates to the analysis of 796,000 deliveries in France in 2012 and mainly on women who developed diabetes during their pregnancy. According to the results, expectant mothers with gestational diabetes give birth more often by cesarean (28%) compared to those without diabetes (20%). They are also more likely to live in premature births (8% versus 6%), or to undergo a pre-eclampsia (2% versus 1%). “For babies, the risk of heart defects at birth is 1.2 times higher than that observed in a woman who has a pregnancy without diabetes“The study specifies. In addition, these complications increase all the more when gestational diabetes is severe, requiring the use of insulin for example.”In this case, a third of deliveries are by cesarean and 9% occur prematurely. Finally, newborns are twice as likely to have a particularly high birth weight “.

When diabetes is quickly diagnosed and the care is adapted and well monitored, diabetes has no effect on the baby. “The most serious complications for the baby (malformations and perinatal deaths) remain rare and, above all, we know that they are increased in cases of unknown type 2 diabetes”. Regarding the main complication, namely cases of large babies at birth (weight greater than 4 kg), it has not been formally demonstrated that it is linked to gestational diabetes. “What is certain, however, is that obese women are more at risk of having a big baby that women of normal build“, says Professor Lepercq.

Yes, childbirth is triggered at 38 weeks of pregnancy in case of type 2 diabetes. On the other hand, in the case of gestational diabetes and in the absence of overweight and of the mother and macrosomia (large baby), one does not trigger not”, specifies Professor Anne Vambergue. In any event, the decision to induce, like that of the delivery route, must take into account different criteria and are therefore to be discussed, on a case-by-case basis, with the mother and the nursing team.

“Pregnant women with risk factors, especially in obesity, are the most at risk of complications, it is essential to to detect as soon as possible to take care of them quickly“insists Professor Lepercq. Ideally, screening should be carried out during prenatal conception, therefore before conceiving the child.”This prevents the fetus from developing while its mother is already diabetic, which would increase the risk of malformations“, explains Jacques Lepercq. Otherwise, blood sugar screening can be done during the first gynecological consultation (before 15 weeks). Finally, ALFEDIAM, a French-speaking association for the study of diabetes and metabolic diseases, recommends systematically look for gestational diabetes by carrying out a blood glucose test in all pregnant women at 28 weeks of pregnancy.

How is the diagnosis of gestational diabetes?

It is a fasting blood sugar level. When the blood sugar is greater than 1.26 g / L, it is a type 2 diabetes before pregnancy. When understood between 0.92 g / L and 1.26 g / L, then it is a Gestational Diabetes. In other patients not previously diagnosed, but with a risk factor, gestational diabetes screening test by one oral hyperglycemia (HGPO test) between the 24th and 28th week of amenorrhea, when the glucose tolerance is less good. Remember that this test replaces the O’Sullivan test which was previously used to measure blood sugar. With the HGPO test, you carry out a first glycemia, on an empty stomach, then swallow glucose (sugar) diluted in water. You then wait in the laboratory because you must not use your glucose reserves and therefore distort the results. A second blood sugar is made an hour later, then a third blood sugar after 2 hours, after which time you have assimilated all this sugar.

On the result side, the fasting glucose level must be less than 0.92 g / L.

After 1 hour, it should be less than 1.80 g / L.

After 2 hours, it should be less than 1.53 g / L.

If one of the values ​​is greater than or equal to these standards, we speak of gestational diabetes.

When the mother-to-be follows hygienic-dietetic rules, she is advised to self-monitor blood sugar. “It is carried out using a blood glucose meter from a drop of blood taken at the fingertip. If the pregnancy diabetes is balanced, and in the absence of other risk factors or associated diseases, the follow-up is that of a normal pregnancy. There may, however, be some additional exams such as: ultrasound, blood test for blood glucose or protein in the urine“, specifies Maxime Mességué, dietitian nutritionist.

In case of diabetes, the future mother is advised to follow a diet. But rest assured, it is not a question of following an exclusion diet and even less starving the mother! It consists of limit fast sugars, favor fiber and foods with a high glycemic index (starchy foods) and balance protein and lipid intake.Of course, the diet must be personalized and adapted to the patient and her eating habits. This is why it is strongly recommended to be followed by a dietician as soon as the diagnosis of diabetes is announced.“, advises Professor Lepercq. Another important element of the diet: having a limited caloric intake. In pregnant women who are overweight before their pregnancy, the ideal is to do not gain more than 8 to 9 kg, or the weight necessary for the smooth running of the pregnancy. “Beyond that, pregnant women take fat for themselves. This aspect should not be trivialized and made aware of them from the start of pregnancy “, insists Jacques Lepercq.

If it is not recommended, physical activity is recommended for pregnant women with diabetes, 30 minutes a day, 5 times a week. In parallel, a self-monitoring of fasting blood sugar with a glycemic meter, 4 to 6 times a day is necessary. “The implementation of these measures is effective in overweight and obese people. There is a decrease in the risk of high blood pressure, fewer complications and babies with lower birth weights“, specifies Professor Jacques Lepercq. After 8 to 10 days, once the diet is in place, the patient reviews her endocrinological medicine. Using the blood sugar monitoring booklet, he can thus check whether the goals are met. “For 80% of women, this is the case. They therefore continue their self-monitoring and their diet and the pregnancy goes normally“reassures Jacques Lepercq. It is only when the diet is not enough (20% of cases) that we associate insulin injections, safe for the baby. Finally, oral antidiabetics are not indicated in the treatment of gestational diabetes.

The future mother must have a balanced diet, and this from the start of her pregnancy.

→ Better to avoid sugary foods,

→ Eat a maximum of 3 fruits per day because they provide sugar,

→ Limit your consumption of sugary drinks such as soda, syrup, fruit juice and use fats in moderate quantities.

→ Practice regular physical activity (30 minutes 3 to 5 times a week).

Diabetes disappears in 98% of cases after childbirth. However, the risk of developing permanent diabetes is not negligible. Hence the importance of quickly returning to normal weight, adopting a balanced diet and having regular physical activity. It is also recommended to monitor blood sugar about six months after the baby is born, and once a year thereafter.

* Interview collected in 2011 and 2019

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