GESTATIONAL DIABETES: WHAT BLOOD SUGAR LEVEL IN PREGNANT WOMEN?

Gestational diabetes is characterized by an abnormally high blood sugar level that is dangerous for the pregnant woman. It usually appears towards the end of the 2nd trimester of pregnancy.

Blood sugar should be checked regularly in pregnant women at risk, with a blood test or urine analysis. Pregnancy diabetes can indeed be the cause of severe complications in pregnant women and their children.

What are the symptoms, causes and risks of gestational diabetes? How high should a pregnant woman's blood sugar level be and how to treat gestational diabetes?




 

What is gestational diabetes?

Gestational diabetes is an abnormal increase in blood glucose (blood sugar) levels during pregnancy. Focus on the causes, symptoms and risks of this disease.

 

What is the cause of gestational diabetes?

Measuring the amount of sugar in the blood, blood sugar should not exceed certain levels. Glucidic tolerance disorder causing more or less severe hyperglycaemia, gestational diabetes can appear or be detected during pregnancy. It usually develops during the 2nd trimester of pregnancy.


During pregnancy, some of the hormones produced by the placenta are hyperglycemic. The body therefore needs to use more insulin to maintain normal blood sugar levels and lower blood sugar levels. However, sometimes the pancreas fails to provide the necessary insulin. The glycemia (blood sugar level) then increases and exceeds the reference levels: this is the onset of gestational diabetes. It usually disappears after pregnancy (postpartum).

It sometimes happens that the pregnant woman is affected by type 2 diabetes without knowing it: the measurements of the blood sugar level carried out during her pregnancy make it possible to reveal this diabetes, which unfortunately does not disappear after childbirth. .

 

Risk factors and symptoms of gestational diabetes

Although most gestational diabetes occurs in women with no risk factors , some are more at risk of developing this disease:

  • overweight or obese women (BMI greater than or equal to 25 kg/m2);

  • women with a family history of type 2 diabetes (in their parents or siblings);

  • women aged 35 and over;

  • women who have given birth to babies weighing more than 4 kg (fetal macrosomia);

  • women who have already developed gestational diabetes during a previous pregnancy;

  • women with polycystic ovary syndrome .

 

It is enough for the pregnant woman to present only one of these criteria to be considered “at risk”. The monitoring of her glycemia will then be reinforced, throughout her pregnancy.


In some cases, gestational diabetes may be asymptomatic and go undetected. This is why it is essential to resort to blood tests in case of doubt.
In other cases, it is characterized by the same symptoms as other types of diabetes:

  • intense thirst;

  • frequent and abundant urination;

  • severe fatigue;

 

What are the risks for the child and the mother?

Excess glucose in the mother's blood is passed to the fetus through the placenta. The child stores this caloric reserve in its organs. It tends to grow too big and get too fat.

If left untreated, gestational diabetes can cause several more or less serious complications:

  • for the mother : pre-eclampsia (or toxaemia of pregnancy: increased blood pressure) with significant weight gain, edema and arterial hypertension, miscarriage, premature delivery, renal complications, difficult delivery due to the heavy weight of the baby (4 kg or more), cesarean delivery, risk of developing type 2 diabetes after pregnancy;
     

  • for the child : fetal distress due to poor oxygenation of the child, hypoglycaemia at birth, loss of consciousness and convulsions, macrosomia (birth weight is greater than 4 kg) and shoulder dystocia (the newborn's shoulders give way difficult exit), respiratory distress, risk of developing type 2 diabetes.
     

In general, gestational diabetes disappears after childbirth, and blood sugar levels return to normal.


How to diagnose and treat diabetes in pregnant women?

When to screen for gestational diabetes? It is proposed during the second trimester of pregnancy, between the 24th and 28th week of amenorrhea (absence of periods). A blood test is offered to pregnant women at risk during the first trimester, then regularly throughout their pregnancy.


Diagnosis and rate not to be exceeded to rule out gestational diabetes

How do you know if you have gestational diabetes? In the first trimester (between 7 and 12 weeks), blood sugar is measured on an empty stomach, using a blood test. The fasting level not to be exceeded is 0.92 g/l , to rule out gestational diabetes.

In the second trimester of pregnancy, blood sugar is measured with:

  • a fasting blood test;

  • OGTT followed by two blood tests: OGTT is Oral Induced Hyperglycemia. The pregnant woman ingests a very sweet drink, containing 75 g of glucose. His blood sugar level is measured one hour after ingestion, then two hours after ingestion. These measurements make it possible to observe the reaction of the pancreas and its ability to regulate blood sugar.

 

Blood sugar levels are normal if:

  • fasting blood sugar is less than or equal to 0.92 g/l;

  • the blood sugar level one hour after drinking the sugar solution is less than or equal to 1.80 g/l;

  • the blood sugar level two hours after drinking the sugar solution is less than or equal to 1.53 g/l.

 

A single worrying level (a level just above, which exceeds the reference values) is enough to make the diagnosis of gestational diabetes.


Treatments

Gestational diabetes should be taken care of as soon as it is detected. To be effective, the treatment must be based on:

  • the patient's understanding of the usefulness of the treatment;

  • self-monitoring of blood sugar levels by the patient: 4 to 6 times a day, pregnant women with gestational diabetes must monitor their blood sugar levels on an empty stomach and after a meal, using a blood sugar meter. His blood sugar should not exceed 0.95 g/l on an empty stomach and 1.20 g/l two hours after the start of a meal (postprandial blood sugar). The levels measured determine the need to resort to insulin treatment or not;

  • compliance with new hygiene and food measures: the patient's diet must be modified, and her weight gain controlled. Pregnant women with gestational diabetes should favor foods with a low glycemic index (low GI), distribute carbohydrate intake throughout the day (over three meals and two snacks, for example), avoid drinks and foods very sweet, favor fibers (which have the effect of slowing down the absorption of carbohydrates and therefore the peak of hyperglycemia) and do not ingest too many calories;

  • maintaining regular physical activity (walking, swimming, gentle gymnastics, exercise bike, etc.), except in the event of a medical contraindication. Sessions can be scheduled three to five times a week, with 30 minutes of exercise per session;

  • follow-up of appointments with the various professionals (general practitioner, nutritionist, gynecologist, diabetologist, etc.);

  • insulin treatment if necessary: ​​these nutritional changes are not enough to regulate blood sugar levels for some women. Rapid insulin injections can then be prescribed (subcutaneous injections performed by the pregnant woman herself). The doctor will tell the pregnant woman at what rate to inject insulin in case of gestational diabetes. Oral antidiabetics are often contraindicated in pregnant women.


Childbirth and postpartum

If the diabetes is well controlled, the patient's pregnancy is managed as a normal pregnancy. Pregnant women with gestational diabetes can successfully keep blood sugar levels low. A caesarean may sometimes be scheduled, especially when the weight of the baby at term is estimated at more than 4,200 kg. If diabetes is poorly managed, labor may be triggered before term (after 39 weeks of amenorrhea in the best case).


The baby must be quickly and regularly fed after birth, the main risk of gestational diabetes remaining for him hypoglycaemia. His blood sugar level will be checked regularly.


At the end of pregnancy and after birth, the blood sugar level of the patient with gestational diabetes will be closely monitored. This will ensure the disappearance of diabetes. Pregnant women who have developed gestational diabetes are more likely to develop type 2 diabetes in the years that follow. It is therefore recommended to carry out regular screening, every 1 to 3 years. The lifestyle and dietary measures adopted during pregnancy can also be followed after childbirth, in particular to reduce the risk of developing type 2 diabetes.

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