1 in 3 women with gestational diabetes is not screened. Screening for gestational diabetes follows a selective mode according to several criteria. It is intended for women with a body mass index (BMI) greater than or equal to 25 kg / m2, an age of 35 years or older, a family history of diabetes, a personal history of gestational diabetes, or a child macrosome. But this selective screening would let women fall through the cracks … Almost a third of cases according to a French team at the Jean Verdier hospital in Bondy.
Physicians assessed screening criteria on more than 18,000 women who gave birth between 2002 and 2010 and who had been screened routinely in their department. However, they found that a significant number of women who did not have predictive criteria such as a BMI greater than 25 kg / m2, could have complications during pregnancy such as pre-eclampsia , macrosomia and shoulder dystocia.
“The frequency of these events was 8.8% in the absence of gestational diabetes and risk factors, 11.1% in the absence of gestational diabetes but with a risk factor of 16.7%. presence of gestational diabetes and in the absence of risk factors and 18.2% in the presence of both, “says Professor Emmanuel Cosson, a diabetologist at Jean Verdier Hospital in Bondy.
“Similarly, women with gestational diabetes and at least one risk factor had higher rates of pre-delivery hospitalization, with no interaction between the risk factor and gestational diabetes. “
This study confirms that selective screening makes it possible to select patients at high risk of gestational diabetes and those with the most events associated with gestational diabetes. However, Professor Cosson and his colleagues consider these diagnostic and prognostic factors “inappropriate” because they miss 34.7% of women with gestational diabetes despite the absence of a risk factor.
In addition, these women, though treated, also presented more events related to gestational diabetes than non-diabetic women. “They may have developed more complications if they had not been diagnosed or treated,” the authors say.
Specialists argue for the adoption of universal screening. Otherwise, they propose to review the risk criteria. They suggest that ethnicity be taken into account because compared to women of European origin, women from North Africa, Pakistan, India or Sri Lanka appeared to be at higher risk of gestational diabetes. And they also recommend lowering the risk thresholds for both age and BMI.
Excessive weight gain during pregnancy, sugar in the urine, fasting glucose above normal, these signs may herald gestational diabetes, a risk factor for type 2 diabetes in mothers. Studies show that the disease must be treated properly to avoid complications.
This gestational diabetes may be temporary and regress after delivery or it may reveal type 2 diabetes. This disease would affect 3 to 9% of women waiting for a child. Unclear statistics that highlight the disparate management of this diabetes.
During pregnancy, the insulin and carbohydrate requirements are greater. Women who already have a small insulin resistance or a high risk of type 2 diabetes can develop diabetes while they are pregnant. A disease that is still insufficiently detected and supported in maternity hospitals. Yet, it puts the baby and his mother at risk during and after delivery. The overweight of the newborn (more than 4 kg at birth) can first of all cause complications during childbirth: cesarean section, fracture of the clavicle or displacement of the baby’s shoulder. The number of “jaundice” and perinatal deaths is also higher than average, and large newborns have an additional risk of developing type 2 diabetes or obesity in their future lives.
Affected women receiving appropriate treatment with personalized dietary advice, insulin injections if needed, and three times a day blood glucose monitoring are less likely to give birth to a fat baby.
In addition, three months after giving birth, they experience less depression or anxiety, and their overall quality of life is much better than that of mothers who did not receive specific care for their gestational diabetes. The treatment of gestational diabetes can therefore effectively reduce perinatal complications. It could also be very helpful in preventing type 2 diabetes for moms and their children.
Pre-eclampsia is defined as blood pressure values greater than 140/90 mmHg and proteinuria greater than 300 mg / 24 h or a cross on the strip, occurring after 20 weeks. In determining as early as possible the risk of pre-eclampsia, the physician can establish an appropriate prenatal consultation program. Whenever blood pressure is measured during pregnancy, a urine sample should be collected for proteinuria.
In women at risk and in the absence of a personal history of preeclampsia, no preventive measure is effective. Pregnant women should be aware of, and recognize, symptoms of pre-eclampsia: headache, visual disturbances such as blurred vision or lightning, tinnitus, epigastric pain, vomiting, sudden edema of the face, hands and eyes. feet, sudden weight gain.
1 in 3 women with gestational diabetes is not screened
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