Gestational Diabetes (During pregnancy)
Definition of gestational diabetes
Gestational diabetes is a disease of pregnancy for 6% of pregnant women. Blood glucose (blood sugar in the blood) is then higher than normal (called hyperglycemia) due to inadequate secretion of insulin. More and more women are confronted during their pregnancy, in part because of strong relationships between this disease and obesity itself increasing.
Risks and consequences of gestational diabetes
Gestational diabetes can lead a set of complications during pregnancy and in the perinatal period in both the mother and the child, but also have long-term consequences.
- For the mother, it increases the risk of hypertension and pre-eclampsia. Preeclampsia is also called "toxemia," that is to say, a hypertension associated with high levels of protein in the urine causing renal failure including a placental ... Gestational diabetes also increases the risk of preterm delivery and cesarean section. In the study DIAGEST Lille 1 (1992-93), the risk of prematurity is more than doubled.
- For the unborn child, it increases the risk of macrosomia (large body), ie the risk of weigh more than 4000g at birth. The frequency of macrosomia is 15 to 30% if gestational diabetes is not supported. It can lead to obstetric complications during childbirth because the baby is too big: shoulder dystocia (lack of commitment shoulders after expulsion of the head) and brachial plexus injury, nerve innervating this mesh upper limbs .
Metabolic complications at birth may be more frequent (especially hypoglycemia and increased blood bilirubin) and, more rarely, respiratory distress due to prematurity.
Screening for gestational diabetes
Screening is open to all women, not just those with risk factors (see below hold against A). The screening takes place between 24 and 28 weeks of gestation (WG). Women with risk factors for gestational diabetes have a screening early in pregnancy and, if negative, it is renewed only 24-28 SA or SA at 32.
Screening (in two stages) based on tests of oral glucose load (OGTT), starting with the test O'Sullivan, of assaying blood sugar one hour after ingestion of 50 g of glucose, the woman is fasting or not. Screening is considered positive if blood glucose is greater than 1.30 g / l (7.2 mmol).
In this case, it is followed by a diagnostic test says (HGPO 100 g) which confirms the reality or non-gestational diabetes. The 100 g OGTT should be performed in the morning, fasting and rest during the test and without changing his diet. Plasma glucose was measured at 0, 60, 120 and 180 min. The figures used as the upper limit of normal, 0.95; 1.80, 1.55, 1.40 g / l.
The diagnosis of gestational diabetes is confirmed if at least two of the four blood glucose levels are abnormal.
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