Gestational diabetes mellitus
You have been told that you are at risk of gestational diabetes but without explaining too much what is it?
Or maybe you know how to be at risk, but you don’t know how to handle the situation?
Good news, you’ve come to the right place.
What is gestational diabetes?
Gestational diabetes, (also known as pregnancy diabetes) is a carbohydrate tolerance disorder first diagnosed during pregnancy, or as the occasion of pregnancy will reveal. This form of temporary diabetes is caused by insulin resistance due to the high production of lactoplacental hormones having an action opposite to insulin, resulting in insulin resistance and / or insulinemia
Gestational diabetes affects 2 to 7% of pregnant women.
When does it appear?
Glucose intolerance appears around the 24 th and 27 th weeks.
What are the risk factors?
Risk factors:
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- Overweight and sedentary lifestyle
- Family history
- Age> 35 years old
- History of glycosuria outside pregnancy or macrosomia (baby + 4kg) or death in utero.
What are the symptoms ?
There are two things you should be aware of:
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- Intense thirst
- Polyuria, that is, you urinate a lot (different from pollakiuria, which is when you urinate often)
And of course fatigue, but this factor is a little less precise because a pregnant woman can be tired for various reasons.
The diagnosis
The diagnosis is made by a blood test where the blood sugar is measured. During the first visit, one can pre-diagnose diabetes if the blood sugar is, on an empty stomach, <0.62g / L, and post-meal <1.10g / L.
At the 24 th week, the test OGTT (oral glucose tolerance) will be performed to make the diagnosis. The blood sugar is measured on an empty stomach, then a solution containing 75g of glucose will be given to the pregnant woman. His blood sugar will be measured. A single blood sugar value beyond the defined thresholds (0.92g / L on an empty stomach; 1.80g / L 1h after the oral glucose load; or 1.53g / L 2h after) is sufficient to diagnose gestational diabetes.
Treatments
Like all forms of diabetes, hygienic-dietetic measures will have to be taken .
However, sometimes this is not enough and for the proper development of the fetus, the prescription of insulin will sometimes be necessary. Insulin injections are favored over oral medications because they can cross the placental barrier and therefore potentially affect the fetus.
And after ?
After birth, the production of the hormone opposed to the action of insulin drops as well as the weight. Also in the majority of cases there is a return to normal.
However, women who developed glucose intolerance during their pregnancy are at higher risk of developing T2D. .
The results
- Short-term consequences :
For the mother:
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- HTA
- Pregnancy toxemia or pre-eclampsia
- Cesarean
For the fetus:
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- Fetal macrosomia. Glucose crosses the placental barrier so the mother’s blood sugar is the same as that of the fetus. If the mother is hyperglycemic, we observe a synthesis of insulin by the fetus which will stimulate the growth of adipose tissue.
- Neonatal hypoglycemia
- Fetal death in utero
- Long-term consequences
For the mother, evolution towards DT2 (30 to 50% of cases)
For the fetus: obesity (at 8 years 50% of cases), and T2D
Why should the mother’s blood sugar be monitored?
Glucose crosses the placental barrier so the mother’s blood sugar is the same as that of the fetus. If the mother is hyperglycemic, the fetus will synthesize insulin which stimulates the growth of adipose tissue leading to the consequences seen above.
The goal is to keep a fasting blood sugar of 0.95g / L, 1 hour after meal of 1.30g / L and 2h after meal of 1.20g / L.
I hope this article has enlightened you. If you would like more advice, please don’t hesitate to contact me. Simple actions will help keep this diabetes under control and prevent you from developing T2D in the future.
