Pregnancy diabetes: some risks but without concern

Said “gestational”this diabetes is “significantly associated with pregnancy complications”, summarizes a large study published Thursday in the British Journal of Medicine (BMJ). This disorder is diagnosed by too high blood sugar during pregnancy. It usually disappears after childbirth, although it increases the risk of developing classic diabetes in the years that follow.

It is considered one of the most common disorders in pregnant women, although it is difficult to give an exact frequency, given the lack of consensus on what constitutes excessive blood sugar. Its frequency has been increasing in any case for several years in the world, partly because overweight, which promotes diabetes, is more and more widespread.

What are the risks for the good progress of the pregnancy, and for the baby himself? This is what the BMJ study sought to better assess. The subject is not new and we already knew the existence of multiple complications, such as an increased risk of cesarean section or premature birth. But this work, led by the Chinese researcher Fangkun Liu, is of an important scale: it is a “meta-analysis”, which compiles some 150 preliminary studies, on more than seven million pregnant women.

Do not worry

The researchers were thus able to confirm the existence of numerous risks and, importantly, better show that they are indeed linked to diabetes itself and not, for example, to the mere presence of being overweight. Among the confirmed risks are not only the use of a caesarean section and premature birth, but also pre-eclampsia – a disorder manifested by hypertension and which can progress to dangerous convulsions – or an abnormally high weight in the newborn. .

In some women, insulin treatment is required. The study mentions particular risks for the latter, including that of breathing difficulties in the baby at birth. However, this work is also reassuring as regards a particularly serious risk which is still poorly assessed: the death of the child at birth.

There is “no obvious difference” for women with gestational diabetes, as well as for the risk of miscarriage, note the authors. Even if the risks remain numerous, this should not lead to panic. Diabetes or not, there is no question of a pregnant woman drastically reducing her diet. “Sometimes, we recover some who, in doubt, no longer eat”, testifies to AFP the dietician Hélène Louvet. “To say: I don’t eat anymore so that it doesn’t go up, that’s not a good long-term calculation”.

A risk of malnutrition

The risk of undernutrition is indeed particularly high in a pregnant woman, which requires a difficult balance in the management of diabetes: controlling blood sugar without frustrating energy needs. Hence the importance of consulting a doctor and dietician. Except that the caregivers themselves lack benchmarks and, in fact, use very different approaches: should certain foods be banned? Split meals to smooth blood sugar?

This is what led French diabetologists to publish, a few weeks ago, detailed recommendations, under the aegis of Ms. Louvet and her colleague Atefeh Nikpeyma. “The dietary recommendations were old and really succinct: there was really little”emphasizes Ms. Louvet.

These new rules, which must obviously be adapted to the situation of each patient, are imprinted with a realistic approach: avoid upsetting the patient’s diet as much as possible. Thus, they do not recommend absolutely banning any sweet food, although it is logically necessary to limit these, or to automatically split meals, even if this remains a possibility depending on the evolution of blood sugar. It’s necessary “take into account the particular situations due to pregnancy but also the various constraints (food habits, tastes, social, financial, professional and organizational situation, etc.) in order to offer the patient the most appropriate support and follow-up”, summarizes this work.