Complications maternelles du diabète gestationnel

Abstract

To estimate maternal outcome of treated or untreated gestational diabetes mellitus (GDM). French and English publications were searched using PubMed and Cochrane library. The diagnosis of GDM gathers a high risk population of preeclampsia and cesarean section (EL3). These risks are positively correlated with the level of hyperglycemia in a linear way (EL2). Intensive treatment of mild GDM compared with routine care reduces the risk of pregnancy-induced hypertension (preeclampsia, gestational hypertension). Moreover, it does not increase the risk of operative vaginal delivery, cesarean section and postpartum haemorrhage (EL1). Overweight, obesity and maternal hyperglycemia are independent risk factors for preeclampsia (EL2). Their association with GDM increases the risk of preeclampsia and cesarean section compared to diabetic women with normal body mass index (EL3). The association of several risk factors (such as advanced maternal age, pre-existing chronic hypertension, pre-existing nephropathy, obesity, suboptimal glycemic control) increases the risk of preeclampsia. In that case, the classical follow-up (blood pressure measurement, proteinuria) should be more frequent than monthly (professional consensus). The risk of cesarean section is increased by macrosomia, whether it was prenatally suspected or not. But this increased risk remains whatever the birth weight is (EL3). Diagnosis and treatment of GDM do not reduce the risk of severe perineal lesions, operative vaginal delivery and postpartum haemorrhage (EL2). Some psychological symptoms, such as anxiety and alteration of self-perception, can occur at the diagnosis of GDM (EL3). The treatment of GDM seems to reduce the risk of postpartum depression symptoms (EL2). Most of the informations published on GDM cover the risks of preeclampsia and cesarean section. Intensive care of GDM reduces theses risks. The pregnancy follow-up should be adjusted to the risk factors.