Gestational diabetes is defined as a “carbohydrate tolerance disorder diagnosed during pregnancy, regardless of the term“explains Dr. Liliane Borgès-Martin, endocrinologist.
In short: gestational diabetes is a particular form of diabetes that specifically affects pregnant women. Moreover, we also speak of “pregnancy diabetes”.
Gestational diabetes: what is happening exactly?
“During pregnancy, and especially in the second and third trimesters, there is a loss of effectiveness of insulin, this hormone which is responsible for regulating the level of sugar in the blood (glycemia), answers Dr. Liliane Borgès-Martin. This loss of efficiency is partly linked to the hormones produced by the placenta.“
If, in most pregnant women, the pancreas naturally produces more insulin to counterbalance this phenomenon, in gestational diabetes, the pancreas fails to keep pace: therefore insulin resistance develops (understand: cells of the body become resistant to insulin, which can no longer get sugar into the organs that need it) then chronic hyperglycemia (that is to say: constantly too high blood sugar levels) – it’s gestational diabetes.
Gestational diabetes: is it common? Pregnancy diabetes affects around 8% of pregnant women: “however, there is an increase in the prevalence, thanks to better screening, but also because of an increase in obesity“analyzes the endocrinologist.
Gestational diabetes: who are the women concerned?
The risk factors for gestational diabetes are now well known:
- Overweight and obesity: when the body mass index (BMI) exceeds 25,
- Age: pregnant women over 35 are at increased risk,
- Family history of diabetes: when you have a sibling or parent with diabetes (type 1 or type 2 diabetes),
- Polycystic ovary syndrome (PCOS),
- History of miscarriage or macrosomia (a baby weighing more than 4 kg at birth),
- Pregnancy hypertension: this is arterial hypertension (hypertension) specific to pregnancy.
To know. “Gestational diabetes is more and more frequent in women in precarious situations“adds Dr. Liliane Borgès-Martin. This pathology is also more common in Asian and African pregnant women.
Gestational diabetes: is it serious, doctor?
If gestational diabetes is not diagnosed and managed, there is indeed a risk to the mother and the unborn baby. Thus, gestational diabetes is associated with an increased risk:
- Pregnancy hypertension: we also speak of gestational hypertension,
- Pre-eclampsia: this disease of pregnancy is characterized by abnormally high blood pressure and is responsible for a third of very premature births in France.
- Premature delivery: we speak of premature birth when the delivery occurs before 8 ½ months of pregnancy (37 weeks of amenorrhea),
- Macrosomia: we speak of macrosomia when the baby weighs more than 4 kilos at birth,
- Hypoglycemia of the newborn: at birth, the baby has an abnormally low level of sugar in the blood (glycemia),
- Delivery haemorrhage: this is an abnormally large loss of maternal blood during childbirth.
And also… In addition, when the mother suffers from gestational diabetes during pregnancy, the child has an increased risk of type 2 diabetes as an adult.
Gestational diabetes: how is it detected?
Screening for gestational diabetes is not systematic: “we screen patients at risk, that is to say pregnant women over the age of 35, obese or overweight pregnant women, pregnant women with polycystic ovary syndrome, etc.“specifies Dr. Liliane Borgès-Martin.
If there is a significant weight gain between the 6th and the 7th month of pregnancy (understand: a weight gain of more than 5 kg), if the baby appears fat on the ultrasound and / or if there is an excess of amniotic fluid, you may also screen for gestational diabetes.
To know. “Every month, we measure the glycosuria of all pregnant women, that is to say the sugar level in the urine: if this is abnormal, this also constitutes a reason for screening for gestational diabetes.“adds the endocrinologist.
How is gestational diabetes screening carried out? In pregnant women who are at risk of gestational diabetes, a fasting blood sugar level will first be taken at the time of pregnancy diagnosis or in the 3rd month of pregnancy: this is a blood test to be taken on an empty stomach.
“Second possible examination: this involves causing hyperglycemia in pregnant women by making them ingest (orally) 75 g of sugar, between the 24th and 28th week of amenorrhea. The blood sugar is measured (using a blood test) before giving the sugar, then 1 hour after and another 2 hours after“adds Dr. Liliane Borgès-Martin.
Gestational diabetes: how is it managed?
Once the diagnosis of gestational diabetes is made, treatment with a diabetologist / endocrinologist is set up. “Most often, hygieno-dietetic advice is sufficient to control pregnancy diabetes.“specifies Dr. Liliane Borgès-Martin.
In short: the pregnant woman must adopt a diabetic diet (a diet low in slow sugars and fast sugars, rich in vegetables and fibers) and practice a physical activity adapted to pregnancy (swimming, walking …). “Indeed, sport helps fight against insulin resistance“develops the endocrinologist.
To know. “In gestational diabetes, a pregnant woman should take her blood sugar 6 times a day using a measurement at the tip of her finger“adds the specialist.
If the hygieno-dietetic measures are not sufficient, insulin injections may be prescribed. “Conventional anti-diabetic drugs are contraindicated during pregnancy“says the doctor.
Gestational diabetes: can it be cured? Good news: in more than 90% of cases, gestational diabetes disappears during childbirth. However, it is necessary (48 hours after childbirth) to control your blood sugar at your fingertip 6 times a day for 2 days. Then, the oral hyperglycemia test should be repeated 3 months after childbirth to check that the disease has disappeared. “In addition, the woman will have to have her blood sugar assayed once a year because gestational diabetes is a risk factor for type 2 diabetes (T2DM).“adds Dr. Liliane Borgès-Martin.
Thanks to Dr. Liliane Borgès-Martin, endocrinologist specializing in gestational diabetes and referent in outpatient medicine on gestational diabetes at the Bretéché Clinic (Nantes – ELSAN group).
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