Gestational diabetes usually appears in the second or third trimester of pregnancy. When compliance with hygiene and dietary measures is not enough to balance it, insulin therapy can be proposed. Update with Dr Isabelle Héron, medical gynecologist and president of the National Federation of Colleges of Medical Gynecology (FNCGM).

The Gestational Diabetes , also called gestational diabetes, characterized by glucose intolerance in pregnant women. It results in an abnormally high sugar level in a patient who had never suffered from diabetes before. The main risk for the baby is to present a macrosomie fetal, i.e. a weight greater than or equal to 4kg at birth , which complicates childbirth and increases the risk of caesarean section. It also risks making a hypoglycemia . The mother-to-be is more exposed to the risk of pregnancy-induced hypertension and pre-eclampsia. The treatment is based on compliance with hygiene and dietary rules and the practice of physical activity. When compliance with these measures is not sufficient, treatment with insulin therapy may be offered.

From what level can the gynecologist decide to install insulin?

A treatment by insulin is put in place when diabetes is not sufficiently balanced despite compliance with lifestyle and dietary rules for at least 10 days . When the blood sugar levels are beyond the objectives, that is to say greater than 1.20g after the meal or greater than 0.95g before the meal.

Slow insulin and gestational diabetes / Rapid insulin and gestational diabetes

There are different types of insulin that the doctor chooses depending on depending on the time of day when the blood sugar is too high for the future mother . ' Les insulines lenses will act for up to 10-12 hours, the very slow ones for 24 hours, and the rapid insulins act very quickly over a short period of time', explains the gynecologist. This type of insulin is prescribed rather for patients who present with high postprandial glycaemia, that is to say hyperglycaemia induced by meals. If a patient has blood glucose levels of 1.40g after lunch, she will be instructed to take a rapid-acting insulin dose at mealtime to cover meal-induced insulin requirements. 'When the morning blood sugar levels are too high, we will ask the patient to take insulin the night before in order to lower the morning blood sugar level', she continues.

Should I induce labor by taking insulin?

' Presence of insulin-treated gestational diabetes is not an indication for induction . The latter is decided by the obstetrician based on the patient's history, risk factors, baby's weight, and diabetes status.' , report notre interlocutrice.

Which insulin protocol at birth?

'There is no protocol to speak of. Insulin is stopped at the time of delivery because insulin requirements drop at that time. When gestational diabetes is well balanced, delivery can proceed normally ' , indicates the gynecologist.

What are the risks of hypoglycemia during or after childbirth?

' There is no risk of hypoglycaemia during or after childbirth for the mother because insulin is stopped when labor starts. On the contrary, there is a risk of hypoglycaemia in newborns when the mother was treated with insulin. The baby is monitored at birth. Most often, gestational diabetes doesn't need insulin.' notes Dr. Isabelle Héron.

Thanks to Dr Isabelle Héron, medical gynecologist and president of the National Federation of Colleges of Medical Gynecology (FNCGM).Source journaldesfemmes.fr