2021-09-03 07:32:00
Gestational diabetes or gestational diabetes is a glucose intolerance which results in an increase in blood sugar in a pregnant woman, says health insurance. The treatment makes it possible to avoid complications in the mother-to-be and the child. A high presence of glycosuria in pregnant women may indicate gestational diabetes.
What exactly is glycosuria?
Glycosuria refers to the presence of glucose (sugar) in the urine.
Does urine normally contain glucose?
Since the presence of glucose in the urine is not normal, the level of glucose in the urine is considered normal when it is zero. But in pregnant women, it is not abnormal to find sugar in the urine. “One in three pregnant patients (non-diabetic) has a positive glycosuria”, confirms Pr Cyril Huissoud, gynecologist-obstetrician. This is due to a physiological decrease in the renal glucose filtration threshold during pregnancy.
When to worry and check fasting blood sugar?
« When it is very high, glycosuria should be suggestive of gestational diabetes and requires fasting glycemic control”. Glycosuria can also be a sign of certain conditions that affect the ability of the kidneys to reabsorb glucose such as Fanconi syndromea fairly rare kidney disorder; Wilson’s diseasea genetic pathology characterized by the toxic accumulation of copper in the body or the interstitial nephritisan inflammation of the area of the kidney called the interstitium.
Positive glycosuria and normal blood sugar
“However, it happens that glucose is found in the urine even when the blood sugar level is normal,” explains Prof. Huissoud. “So we’re talking about glycosurie normoglycémique. This can happen during pregnancy, a time when the kidney’s glucose filtration threshold is lowered. Glycosuria is therefore not necessarily abnormal in pregnant women. ».
How to detect glycosuria in pregnant women?
The glycosuria screening is a very simple test that consists of urinate in the morning on an empty stomach in a small bottle provided for this purpose. The urine collected is then analyzed using a paper strip to detect the presence of sugar. “Faced with a high glycosuria in a pregnant woman not known to be diabetic, a determination of the fasting blood sugar will be requested in order to look for diabetes”, specifies Prof. Huissoud.
« If the diagnosis of gestational diabetes is confirmed, the patient will be offered to meet with a dietitian. As blood sugar levels are now much more suitable for detecting diabetes and monitoring its development, the glycosuria test is doomed to disappear”.
How to detect gestational diabetes?
Screening for gestational diabetes is done from the first trimester of pregnancy via a fasting blood glucose test. “During the blood test, it is important to be fasting for at least 12 hours to prevent blood sugar control from being distorted”, underlines the specialist.
This dosage is completed, if necessary, in the second trimester with a test oforally induced hyperglycemia (OGTT). This examination, which consists of drinking 75 g of glucose on an empty stomach, is generally quite dreaded by pregnant women in whom it can cause nausea or even discomfort. A first measurement of blood glucose is carried out on an empty stomach in the form of a blood test or using a lancing device to collect a small drop of blood from the fingertip. This gesture is painless. The patient should then drink a glass of a very sweet solution and avoid moving around. The blood sugar level will be measured after one hour; then two hours after ingesting the liquid.
What is the normal blood sugar level during pregnancy?
“A single blood glucose value above the set thresholds (0.92 g/L on an empty stomach ; or 1.80 g/L one hour after oral glucose load ; or 1.53 g/L 2 hours later) is enough to diagnose gestational diabetes”, indicates the French Federation of Diabetics (source 2). The concept of intolerance to sugar no longer exists, there is only “normal blood sugar” or gestational diabetes, specifies the latter.
What are the risks of gestational diabetes?
Also called gestational diabetes, gestational diabetes usually appears during the second trimester and disappears after delivery. This glucose regulation disorder which leads to excess sugar in the blood (chronic hyperglycaemia) affects one in ten women. Gestational diabetes with risque for mother and child, it must be monitored and treated.
In pregnant women
Gestational diabetes exposes the pregnant woman to a increased risk of hypertension, premature delivery and the possibility of developing type 2 diabetes after pregnancy
In the baby
It also exposes the baby to macrosomie (i.e. a birth weight greater than 4 kg), at a neonatal hypoglycemia and at the risk of later developing a Type 2 diabetes. “The fetus is used to an influx of sugar in utero because the mother has difficulty balancing her blood sugar,” explains Prof. Huissoud. “It will therefore secrete insulin to regulate its sugar level. However, at birth, the baby retains a high insulin level in the blood while there is no longer an influx of sugar from the mother, which can lead to hypoglycemia or even convulsions.
Which women are at risk?
Several factors favor gestational diabetes:
- A late pregnancy : the prevalence reaches 14.2% among women aged over 35;
- A high BMI (body mass index) : Obese and overweight women are more likely to develop gestational diabetes;
- A family history of type 2 diabetes;
- A history of gestational diabetes : women who had gestational diabetes during a first pregnancy have a 50% risk of developing it again during a new pregnancy.
High glycosuria: how to lower your glucose level?
The discovery of gestational diabetes is generally followed by a consultation with a dietician so that the patient can adapt her diet. “For example, this one should limit your intake of fast sugars and favor slow sugars like whole grains. We must also be wary of false friends such as fresh fruit which is high in sugar,” explains Prof. Huissoud.
At the same time, the patient can be asked to measure your blood sugar every day using a lancing device and of note the results in a notebook. “If the diabetes improves rapidly with dietary rebalancing, we continue monitoring. If, on the contrary, the diabetes is still not balanced, insulin treatment can be put in place”.
Diabetes and pregnancy: what management?
Pregnant diabetic women are subject to special monitoring. Indeed, chronic hyperglycemia can cause maternal complications and fetal malformations.
“Diabetic women who are planning a pregnancy must imperatively make a check-up with their diabetologist before conceiving a baby. Usually they will be asked to try to balance their sugar level as much as possible before getting pregnant because they may subsequently develop kidney problems or diabetic retinopathy, that is to say a disease of the retina,” explains Prof. Huissoud. Insulin-dependent women will need to carefully monitor their blood sugar levels each day and adjust their insulin injections.
“Pregnant women must perform self-monitoring of blood sugar, 4 to 6 times a day. Objective: to keep blood sugar levels at an acceptable level, i.e. less than or equal to 0.95 g/L on an empty stomach and less than 1.20 g/L two hours after the start of the meal”, adds the French Federation of Diabetics.
As high blood sugar can lead to fetal malformations – including cardiomyopathy, malformation of the heart – it is very important that diabetes is well balanced and followed.
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