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What is Gestational diabetes

The gestational diabetes or gestational diabetes is diabetes that occurs during pregnancy, usually during the 2or 3quarter. Doctors are also diagnosed with gestational diabetes when glucose intolerance (prediabetic status) is detected in a pregnant woman. In other words, gestational diabetes is not always straightforward diabetes, but in all cases, blood sugar (or “sugar” in the blood) is higher than normal.

Sometimes diabetes was present before pregnancy, but had not been detected yet. A blood glucose testis performed for pregnant women in early pregnancy. This makes it possible to quickly treat women with gestational diabetes, and to carefully control their sugar (blood sugar) levels at conception, which allows the reduction of spontaneous abortions, malformations such as macrosomia (a child of too much weight) and complications. perinatal (around the time of delivery).

In Canada, gestational diabetes is a growing concern, affecting approximately 7% of pregnant women. The rate is much higher in indigenous populations: 13%, on average.

Pregnancy and glucose metabolism

During the 2 and 3 trimesters of pregnancy , the need for insulin for pregnant women are 2 to 3 times higher than normal. This could be explained by the gradual increase during pregnancy in the production of “anti-insulin” hormones (for example, placental hormones, cortisol and growth hormones), which reduce the effects of insulin. on the body. They are essential to the good progress of a pregnancy, therefore to the health of the fetus and the mother. Normally, this resistance to insulin stimulates the pancreas to produce more insulin to compensate. However, in some women, the pancreas does not produce this surplus of insulin. At home, then settles too high sugar level in the blood, hyperglycemia.

Possible consequences

Gestational diabetes puts mothers and children at increased risk:

For the mother

  • Hypertension and edema (preeclampsia).
  • spontaneous abortions
  • Urinary infection.
  • Cesarean delivery (in case of high weight of the child).
  • Premature delivery.
  • Type 2 diabetes after pregnancy.

For the child

  • Weight exceeding 4 kg (9 lb) at birth (macrosomia). This is the case for 17% to 29% of children born to mothers with gestational diabetes, compared to 5% to 10% for all mothers.
  • Neonatal hypoglycemia.
  • Exaggeration of the jaundice of the newborn.
  • Respiratory distress syndrome.
  • May develop diabetes, most often type 2. (It is suspected that gestational diabetes may lead to an increased risk of type 2 diabetes in the unborn child later in adulthood because of ‘early exposure to a potentially harmful environment in the prenatal period).

After childbirth

In 90% of cases, gestational diabetes disappears within a few weeks after delivery. However, gestational diabetes increases the risk of diabetes in women afterwards. For example, some women with gestational diabetes, some months or years later, suffer from type 2 diabetes or, more rarely, from type 1 diabetes.

feeding

Gestational diabetes is not a contraindication for breastfeeding . On the contrary, studies indicate that it can confer some protection against diabetes (see our Diabetes Type 1 chart). This is especially important as children of mothers who have pregnancy diabetes are probably at higher risk of becoming diabetic.

Note. Women who know themselves to be diabetic and want to have children must absolutely obtain a rigorous medical follow-up that must begin before conception .

SYMPTOMS of Gestational diabetes

As with other types of diabetes, a pregnant woman with gestational diabetes does not suffer from anything (she is said to be asymptomatic ). In rare cases, it may present the following symptoms:

  • tiredness unusual for a pregnant woman;
  • of urination abundant;
  • an intense thirst .
  • weight loss or on the contrary weight gain very fast.

People at risk

  • Be Hispanic (Latin American), Native American, African American or Southeast Asian.
  • Be aged 30 and over.
  • Have a family history of diabetes.
  • Have a personal history of glucose intolerance or “prediabetes”.
  • Have had any of the following problems during a  previous pregnancy  : gestational diabetes, hypertension, repeated urinary tract infection, hydramnios (excess amniotic fluid).
  • Have polycystic ovary syndrome
  • Have had a baby weighing more than 4 kg (9 lb.) at birth (macrosomia).
  • Suffer from obesity or under restrictive diets.

Risk factors for Gestational diabetes

  • Overweight and obesity are important risk factors.
  • Taking oral corticosteroid medications   over a long period.

Prevention of gestational diabetes

Basic preventive measures
The best way to prevent diabetes during pregnancy is to maintain a healthy weight and have a healthy lifestyle (eating well, exercising regularly …) before getting pregnant.

In obese women, it will be wise to lose weight before pregnancy (without falling into the trap of restrictive diets) especially since there is a family of diabetes or the future parturient has had repeated miscarriages .

For more information, see the Prevention section of our Type 2 Diabetes Card. Also, take our testto determine your Body Mass Index (BMI) .

Measures to prevent complications in the mother and child

Screening

It is possible to detect diabetes at the beginning and during pregnancy. The goal is to prevent as much as possible complications that could occur in the mother and the child. It is important to discuss screening with your doctor. The decision to screen or not depends on several factors, such as the health status of the pregnant woman and the progress of her previous pregnancies, if any. Its values ​​and risk tolerance also sometimes come into play.

Screening methods

Different tests can be used to detect abnormally high glucose levels.

  • Test of hyperglycemia caused (ingestion of 50 g to 75 g of glucose followed by a reading of the blood glucose 2 hours later).
  • Fasting glucose test.
  • Determination of blood A1C hemoglobin (normally reserved for women known as diabetics), which allows the average blood glucose level to be estimated over the last 3 months.

Screening in the 1stquarter

  • Recommended for all pregnant women who have many risk factors for diabetes. The test takes place at the 1stmedical monitoring of pregnancy. If the result is negative, another test is still suggested later in the pregnancy.

Screening between the 24 th and 28 th weeks of pregnancy

  • The International Diabetes Federation recommends it to all pregnant women .
  • Women with a very low risk of diabetes (Caucasian, under 25, thin, no personal or family history of glucose intolerance) may avoid it, according to the American Diabetes Association.

Evolving practices

Les experts sont formels : il est primordial de dépister le diabète gestationnel au 1er trimestre chez les femmes à risque. Un diabète (de type 1 ou de type 2) qui se manifeste en début de grossesse signifie qu’il était présent avant la grossesse, mais qu’il n’était pas encore déclaré ou diagnostiqué. Si le foetus est en contact dès les 1ers mois avec un milieu diabétique, des complications graves peuvent s’ensuivre, comme des malformations congénitales ou même parfois la mort foetale.

Screening between the 24 th and 28 th weeks of pregnancy has long been reserved for pregnant women at risk for diabetes. The need to extend screening to all pregnant women has been widely debated. Indeed, the ability of treatment to prevent complications among this large population was not clearly demonstrated. In addition, deciding to treat a pregnant woman requires a lot of caution. The treatment is mainly based on insulin which requires sometimes daily and daily injections.

However, recent data support the usefulness of routine screening . A major study published in 2008 and conducted among 25,505 women in 10 countries, has established a direct relationship between blood sugar between 24 thand 32 thweeks of pregnancy and some perinatal complications in the mother and the child. In addition, syntheses of studies published in 2009 and 2010 have highlighted the effectiveness of treatment of gestational diabetes in preventing multiple complications (for example, it may reduce the risk of cesarean section), even when diabetes is “mild”.

In the light of this data, most specialists and expert groups now recommend routine screening. In practice, the advice can still vary from doctor to doctor and depending on the case. When glucose intolerance or diabetes is detected, changes in diet and lifestyle are often enough to control blood glucose levels (see Medical Treatments).

Medical treatments for gestational diabetes

More and more scientific evidence supports the efficacy of treating gestational diabetes in reducing complications. The treatment is adapted on a case by case basis. A blood glucose meter is essential to check and correct the quality of blood glucose control as needed.

Some changes in diet and lifestyle are often enough to keep blood sugar at acceptable levels, and for the mother and baby to be healthy. For example, monitor daily intake of carbohydrates ( sugarscontained in fruit juices, soft drinks, syrups, sweets, fruits, jams, compotes) and eat less foods high in saturated fat (butter , cream, fat contained in fatty meats, deli meats, palm oil, etc.). The diet must of course respect the nutritional needs of the pregnant woman. Follow-up by a nutritionist and / or dietitian throughout the pregnancy is recommended. See our Diabetes overview for an overview of diet and physical activity appropriate for people with diabetes.

Physicians also focus on weight control for women with gestational diabetes. Weight gain during pregnancy should not be too important to preserve as much as possible the health of the woman and her child. The stronger the woman is at the beginning of the pregnancy, the less she has to gain weight.

Le régime alimentaire est adapté au profil de chaque femme enceinte et il a pour but d’optimiser l’équilibre glycémique, réduire la lipolyse source de corps cétoniques. Le régime proposé doit couvrir impérativement les besoins nutritionnels quotidiens qui s’établissent globalement à 1800-2000 Kcal/j répartis idéalement en quatre prises quotidiennes minimum dont une au coucher afin de réduire la période de jeûne nocturne. Seule la présence d’une obésité peut inciter à réduire davantage la ration calorique journalière car la prise totale de poids à la fin de la grossesse doit, dans ce cas, être la plus minime possible.

The insulin is reserved for women for whom the change in lifestyle does not allow itself to control blood sugar. Most antidiabetic medicines are contraindicated in pregnancy. According to recent studies, metformin is an effective alternative to insulin, and safe enough to offer pregnant women. However, insulin remains better than antidiabetic drugs.

Note . Women who have gestational diabetes are at higher risk for type 2 diabetes. More than half of them suffer from it later in their lives. The proposed treatment to control pregnancy diabetes also helps to maintain health for as long as possible. Encouragingly, women who have had gestational diabetes and regain their normal weight after delivery halve their risk of developing type 2 diabetes.

Important measure . Women who have had gestational diabetes would benefit from having their blood glucose checked regularly.

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