Gestational diabetes

Gestational diabetes is a particular type of diabetes, because it only appears in some pregnant women from the second trimester onwards, and disappears just a few days after delivery (but increases the risk of type 2 diabetes by about 50% after that).
Apparently, 5% of pregnant women are affected by this disease, and this number is increasing, especially among younger women. It is one of the most common disorders in pregnant women.1 .
During pregnancy, the occurrence of insulin resistance appears in a physiological (natural) way to preserve glucose for the fetus. However, in some women, this feature is taken to an extreme, resulting in gestational diabetes.

Women at risk are those who are overweight. It is important to note that excess weight gained during pregnancy is not in question, as opposed to pre-existing excess weight. In addition, heredity also plays a role. A woman who has already developed gestational diabetes is more at risk in a future pregnancy, which is why she will be affected faster by this disease.

In gestational diabetes, the symptoms are similar to those developed in type 2 diabetes , such as excessive thirst and the frequent urge to urinate.

For the diagnosis, the doctor uses glycemia (measurement of the blood sugar rate), glycosuria (urine sugar rate) and the glucose tolerance test. Screening is done during the 24th and 28th weeks of pregnancy. However, in women at risk, screening can be done earlier, around the 12th week of pregnancy.

Gestational diabetes can lead to complications in the mother and fetus, so it is necessary to diagnose and take charge. In fact, this disease can cause pre-eclampsia and miscarriage in the mother. It also increases the risk of these women developing type 2 diabetes after childbirth. The fetus may suffer from macrosomia (excess birth weight > 4 kg). A large study published on May 25, 2022 in the scientific journal BMJ(DOI : 10.1136/bmj-2021-067946 ) documented the various complications of gestational diabetes. This study is a “meta-analysis”, which compiled about 150 previous studies, considering more than seven million pregnant women.

The physician in charge will first monitor maternal nutrition. The mother can also self-monitor by measuring her blood glucose. It is recommended to take at least 4 measurements a day: fasting and after each meal. If dietary measures are not enough, the doctor may prescribe insulin injections as a first choice. Then, if necessary, metformin or glibenclamide can be prescribed, because these molecules are also considered effective without penetrating the placental barrier. This avoids side effects for the baby.

In diagnosed cases of gestational diabetes, it is advisable for the mother to exercise moderately and pay attention to her diet.

Definition

Gestational diabetes is a particular type of diabetes. It usually affects non-diabetic women during pregnancy (which often manifests itself between the 24th and 28th week of pregnancy) and disappears after a few days of the baby’s birth.

During pregnancy, it is normal for the mother’s body to be more resistant to insulin, thus preserving glucose for the fetus. In gestational diabetes, this resistance is higher.

In fact, there are several risks during pregnancy, such as diabetes, hypertension, etc. These high-risk pregnancies should be specially monitored by the doctor.

Regarding gestational diabetes, there are especially important complications for the mother and the baby, such as: macrosomia (excess weight at birth), abnormalities, miscarriages, etc …

In gestational diabetes, the mother’s risk of developing type 2 diabetes increases 7-fold.

Gestational diabetes can be controlled by changing nutrition, moderate physical activity, and medication if needed.

Pregnant women with gestational diabetes are advised to control their blood sugar until the end of their pregnancy. This will allow the mother to control her eating, for example, or control insulin injections. In some cases, the doctor may also prescribe oral antidiabetic medications, usually metformin or glibenclamide.

Epidemiology

As with type 1 or type 2 diabetes, the frequency of occurrence of gestational diabetes depends on ethnicity. In Europe, for example, it can affect between 3-6% of the population, while in the rest of the world, the percentage is slightly higher: from 5 to 10%.
In June 2016, the University of Toronto (Canada) published a study on gestational diabetes estimating that between 3 and 13% of pregnant women may suffer from this form of diabetes.

The trend is growing, especially among young women.

If a woman has gestational diabetes, her risk of developing type 2 diabetes during the next 5 years of pregnancy increases by 20 to 50%, according to the University of Toronto.

According to a press release from Brigham and Women’s Hospital in the United States, according to a publication of a study on gestational diabetes, about 50% of women who have gestational diabetes will develop type 2 diabetes in the years after pregnancy.

Causes

As we saw in the “Gestational diabetes definition” section, this type of diabetes affects pregnant women who are not diabetic. The disease disappears after the baby is born.

During pregnancy, numerous changes occur in the pregnant woman’s body, however, these changes can lead to complications that can be dangerous for the mother and the child.
In general, during pregnancy, the transformation of sugar is slower, but when the blood sugar level is very high, we speak of gestational diabetes.

During “normal” pregnancy, the expectant mother’s body becomes resistant to insulin in order to save glucose for the fetus. This process usually appears in the second trimester of pregnancy, becomes more pronounced during the third trimester, and disappears only after delivery.

In women with gestational diabetes, insulin resistance is very strong. In addition, changes in insulin secretion are also observed.

This can cause complications for both mother and baby.

When insulin resistance persists after giving birth, we also call it gestational diabetes, as it appeared during pregnancy. Therefore, it is necessary for insulin resistance to be first diagnosed during pregnancy to be called gestational diabetes.

The use of antipsychotic drugs (indicated mainly against schizophrenia) may lead to an increased risk of developing gestational diabetes, according to a study conducted by Brigham and Women’s Hospital and Harvard University, in the United States. Continuing to take olanzapine and quetiapine, two atypical antipsychotics, has been shown to increase the risk of gestational diabetes compared with women who discontinue these medications. This study was published May 7, 2018 in the American Journal of Psychiatry (10.1176/appi.ajp.2018.17040393).

Groups of risk

The following women are at increased risk of developing gestational diabetes:

– overweight

– age (> 35 years)

– ethnic origin

– history of type 2 diabetes in the nuclear family (parents and siblings)

– history of gestational diabetes in a previous pregnancy

– Stein-Leventhal syndrome or polycystic ovary

Overweight
Do not confuse weight gain during pregnancy with pre-existing overweight. As with type 1 and 2 diabetes, being overweight during pregnancy is a risk factor for gestational diabetes.

Ethnic origin
It appears that Caucasians (white women) are less affected by gestational diabetes. Thus, this disease affects more people of African or Asian origin.

History of Gestational Diabetes in a Previous Pregnancy
Women who have developed gestational diabetes during their previous pregnancy, screening test is done before by the gynecologist. One should not wait for the 24th week of pregnancy. This allows for a faster response and avoids complications.

Stein-Leventhal syndrome or polycystic ovary
This syndrome is still little known, but the result of a hormonal imbalance can cause the onset of insulin resistance.

Symptoms

The symptoms of gestational diabetes correspond to the symptoms of diabetes:

– polyuria (constant need to urinate)

– severe thirst (due to polyuria)
– unusual tiredness

When these symptoms occur, a quick consultation is recommended.

Complications

As with all diabetics, the blood sugar level is abnormal.

A large study published on May 25, 2022 in the scientific journal BMJ (DOI: 10.1136/bmj-2021-067946 ) documented the various complications of gestational diabetes. In summary, this 2022 study confirms the risks for women suffering from this type of diabetes to resort to a cesarean section and premature delivery, in addition to also increasing the risks of developing pre-eclampsia – a disease manifested by hypertension and which can progress to dangerous seizures. – or an abnormally high birth weight. However, this work is also reassuring for a particularly serious and still poorly evaluated risk: the death of the child at birth. There is “no clear difference” from women with gestational diabetes, as well as in the risk of miscarriage, the authors note.

In the case of pregnant women, diabetes also affects the growth and development of the child, which is why gestational diabetes must be controlled and treated. We can therefore list two types of possible complications. Complications for the mother and complications for the fetus.

Potential maternal complications of gestational diabetes

– Risk of preeclampsia and cesarean section
– Risk of miscarriage
– High risk of developing type 2 diabetes
– Higher risk of developing gestational diabetes in the next pregnancy

Pre-eclampsia and cesarean section

Pre-eclampsia is the onset of high blood pressure during the second trimester of pregnancy. Without support, pre-eclampsia can lead to eclampsia, i.e. the occurrence of seizures of the same type as epilepsy and other serious complications for the mother and child, such as:

– Renal failure
Poor perfusion of the placenta, resulting in poor fetal development, a growth retardation
– Retinal detachment in the mother
– etc.

Potential complications for the unborn child

– High birth weight (macrosomia, 4 to 4.5 kg) and a cesarean section is then scheduled

Diagnosis

The clinical signs of gestational diabetes should alert the gynecologist.

The doctor will confirm the diagnosis through different tests:

– glycemia: measurement of blood sugar
– glycosuria: measurement of sugar in the urine
– provoked hyperglycemia: glycemic curve in the patient: fasting glycemia is measured and then every half hour for two hours, after giving a precise amount of glucose ( sugar) according to your body weight. This test allows you to analyze the absorption of sugar. In a healthy person, blood glucose drops quickly and ensures good absorption of sugar.

This test is recommended for all pregnant women who are 24 to 28 weeks pregnant.

When there are risk factors that can lead to the development of gestational diabetes, it is recommended to be tested as early as the 12th week of pregnancy. If the result is negative, the test will be repeated during the 24th to 28th week of pregnancy.

The reference values ​​that indicate diabetes are as follows:

Fasting blood glucose: ≥ 5.1 mmol / l

Blood glucose 1 hour after glucose tolerance test (provoked hyperglycemia): ≥ 10 mmol/l

Blood glucose 2 hours after glucose tolerance test (provoked hyperglycemia): ≥ 8.5 mmol/l

The determination of glycated hemoglobin (HbA1c), however, is not indicated for the screening of gestational diabetes.

Treatments

At first, the doctor will advise his patient to watch her diet. A healthy diet is essential for pregnant women, to ensure the health of the baby and to regulate diabetes.

 regularly eat vegetables and salads

 eat enough whole grains

 decrease and even eliminate sugar, as well as sweet drinks, lemonades, juices, sweets, chocolate, cookies.

Physical activity can also be advised, but in moderation. Not all physical activities are advised during pregnancy.

Physical activities indicated during pregnancy are swimming, cycling, walking.

It is not recommended to practice violent sports or sports with a high risk of falling, such as combat sports, athletics, skiing or horseback riding.

Finally, if all measures are not enough to control gestational diabetes, the doctor may prescribe insulin to inject.

The latter should also monitor glycemia (blood sugar level), adapt their diet and, if necessary, insulin treatment (the amount of insulin to be injected). Testing is recommended on an empty stomach and after each meal.

As an alternative to insulin, there are metformin and glibenclamide, as placental transfer is considered low. However, the French National College of Gynecologists and Obstetricians does not systematically recommend these treatments.

Tips

– Gestational diabetes usually disappears after delivery, and in most cases, it leaves no sequelae if treated correctly.

– That is why it is important to inform your doctor quickly if family members have had gestational diabetes (hereditary factor) and if you have already given birth to a child with a high birth weight (over 4 kg). It is possible to develop during pregnancy, gestational diabetes. Therefore, it is paramount that the gynecologist order the survey for early detection (before the 24th week of pregnancy), so that pregnant women can be treated quickly.

– During pregnancy, it is important to control your weight through diet and physical activity, while having fun. The mother-to-be should ensure good hydration and distribute meals and snacks well.

– If insulin treatment is really necessary, the pregnant woman should not be concerned, because this medication does not cross the placental barrier and therefore will have no effect on the child.

– It is recommended to regularly carry out the test that measures blood glucose, to adjust your diet and the dose of insulin to be injected.

Prevention

– It is not always possible to prevent gestational diabetes, if genetic factors are involved, for example. Other risk factors can be controlled such as overweight, diet and sedentary lifestyle.

– When gestational diabetes is diagnosed, hygienic-dietary measures are recommended in the first place. Modify your lifestyle. This change alone can be beneficial for almost 80% of patients.

– First it is necessary to focus on a healthy diet, eating 5 to 6 meals a day. Calorie intake should be distributed as follows: 10% for breakfast, 30% for lunch and 40% for the evening, as well as 2-3 snacks.

– The quality of calorie intake also comes into question. It is recommended to consume carbohydrates with a low glycemic index, so that the glucose rate does not increase too much after meals.

– For the well-being of mother and child, you should never reduce your diet drastically, the essential thing is to eat healthily. Every pregnant woman should consume at least 1600 kcal per day.

– Physical activity is also recommended because it also helps to improve insulin sensitivity. The body manages blood glucose better. The expectant mother can 3 times a week do some exercises for 30-45 minutes. Walking and swimming are ideal, but should be done in moderation. It is recommended to stop every 15 minutes for hydration and blood sugar control.

– With these lifestyle changes, it will be possible to avoid being overweight. The latter may be a risk factor for gestational diabetes.

Sources & References:
Brigham and Women’s Hospital, American Journal of Psychiatry (10.1176/appi.ajp.2018.17040393).

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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