Incidence des complications materno-fœtales au cours du diabète gestationnel
Résumé
Introduction: Le diabète gestationnel (DG) est associé à des complications, aussi bien maternelles que fœtales, en rapport avec
l’hyperglycémie maternelle.
Objectif: Décrire l’incidence des complications maternelles et fœtales du DG dans une maternité de référence de la région de Tunis (2019-2020).
Méthodes: Il s’agissait d’une étude longitudinale prospective descriptive et analytique, portant sur 220 patientes suivies pour DG à l’unité de
recherche «Diabète et grossesse» du service C à l’Institut National de Nutrition de Tunis durant une période de 18 mois(juillet 2019-Décembre
2020). Les patientes étaient réparties en deux groupes: le Groupe 1(G1) était composé de patientes traitées par des règles hygiéno-diététiques
associées à une insulinothérapie(n=68) et le Groupe 2(G2) composé de patientes traitées par des règles hygiéno-diététiques seules (n=152).
Résultats: Au terme de notre étude, 63,6% des patientes ont accouché par césarienne et 5% ont développé une hypertension gravidique. Les complications
néonatales étaient dominées par la macrosomie (13,5%) et la détresse respiratoire transitoire(11,4%).Les patientes traitées par insuline avaient une incidence plus
élevée d’hypertension gravidique(G1:11,9% versus G2:2,1%;p=0,03).La fréquence du recours à la césarienne était similaire dans les deux groupes (G1:64,7% versus
G2:63,2%;p =0.785).Il n’y avait pas une différence entre les deux groupes en ce qui concerne l’incidence des complications fœtales notamment de macrosomie (G1:17,6%
versus G2 :11,2%; p=0,203), de détresse respiratoire transitoire (G1:11,8% versus G2:10,5%; p=0,781) et de prématuritéc(G1:7,4% versus G2:4,6%;p=0,452).
Conclusion: Les patientes traitées par insuline avaient une incidence plus élevée d’hypertension gravidique. Toutefois, il n’y avait pas une
différence significative entre les deux groupes en ce qui concerne l’incidence des complications fœtales et néonatales.
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Références
Wery E, Vambergue A, Le Goueff F, Vincent D, Deruelle P. Impact of the new screening criteria on the gestational diabetes prevalence. J Gynecol Obstet Biol Reprod 2014;43(4):307‑13.
American DiabetesAssociation . 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2021. Diabetes Care 2021;44(Suppl 1):15‑33.
Deputy NP, Kim SY, Conrey EJ, Bullard KM. Prevalence and Changes in Preexisting Diabetes and Gestational Diabetes Among Women Who Had a Live Birth - United States, 2012- 2016. MMWR Morb Mortal Wkly Rep 2018;67(43):1201‑7.
Szmuilowicz ED, Josefson JL, Metzger BE. Gestational Diabetes Mellitus. Endocrinol Metab Clin North Am 2019;48(3):479‑93.
Zhu Y, Zhang C. Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes : a Global Perspective. Curr Diab Rep 2016;16(1):7.
Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358(19):1991‑2002.
Berger H, Gagnon R, Sermer M, Basso M, Bos H, Brown RN, et al. Diabetes in Pregnancy. J Obstet Gynaecol Can 2016;38(7):667-679.
Kautzky-Willer A, Harreiter J, Winhofer-Stöckl Y, Bancher-Todesca D, Berger A, Repa A, et al. Gestational diabetes mellitus (Update 2019). Wien Klin Wochenschr 2019;131(Suppl 1):91‑102.
Jovanovic L. Point: Oral hypoglycemic agents should not be used to treat diabetic pregnant women. Diabetes Care 2007;30(11):2976‑9.
Jovanovic L, Pettitt DJ. Treatment with insulin and its analogs in pregnancies complicated by diabetes. Diabetes Care 2007;30 (Suppl 2):220-224.
Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361(14):1339‑48.
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352(24):2477‑86.
Aktun LH, Yorgunlar B, Karaca N, Akpak YK. Predictive Risk Factors in the Treatment of Gestational Diabetes Mellitus. Clin Med Insights Womens Health 2015;8:25‑8.
American DiabetesAssociation. 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2020. Diabetes Care 2020;43(Suppl 1):183‑92.
Billionnet C, Mitanchez D, Weill A, Nizard J, Alla F, Hartemann A, et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 2017;60(4):636‑44.
Mortier I, Blanc J, Tosello B, Gire C, Bretelle F, Carcopino X. Is gestational diabetes an independent risk factor of neonatal severe respiratory distress syndrome after 34 weeks of gestation? A prospective study. Arch Gynecol Obstet 2017;296(6):1071‑7.
O’Sullivan EP, Avalos G, O’Reilly M, Dennedy MC, Gaffney G, Dunne F, et al. Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria. Diabetologia 2011;54(7):1670‑5.
Wendland EM, Torloni MR, Falavigna M, Trujillo J, Dode MA, Campos MA, et al. Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in PregnancyStudy Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth 2012;12:23.
Fadl HE, Ostlund IKM, Magnuson AK, Hanson US. Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003. DiabetMed 2010;27(4):436‑41.
Cheung NW, Oats JJN, McIntyre HD. Australian carbohydrate intolerancestudy in pregnantwomen: implications for the management of gestationaldiabetes. Aust N Z J Obstet Gynaecol 2005;45(6):484‑5.
Casey BM, Rice MM, Landon MB, Varner MW, Reddy UM, Wapner RJ, et al. Effect of Treatment of MildGestationalDiabetes on Long-TermMaternalOutcomes. Am J Perinatol 2020;37(5):475‑82.
Yanagisawa K, Muraoka M, Takagi K, Ichimura Y, Kambara M, Sato A, et al. Assessment of predictors of insulintherapy in patients withgestationaldiabetesdiagnosedaccording to the IADPSG criteria. Diabetol Int 2016;7(4):440‑6.
Watanabe M, Katayama A, Kagawa H, Ogawa D, Wada J. Risk Factors for the Requirement of AntenatalInsulinTreatment in Gestational Diabetes Mellitus. J Diabetes Res 2016; 2016:9648798.
Benhalima K, Robyns K, Van Crombrugge P, Deprez N, Seynhave B, Devlieger R, et al. Differences in pregnancy outcomes and characteristics between insulin- and diettreated women with gestational diabetes. BMC Pregnancy Childbirth 2015;15:271.
Chen Z, Liu W, Sun X, Zhu L. Clinical study on the association between pregnancy-induced hypertension and insulinresistance. ExpTher Med 2017;13(5):2065‑70.
Ducarme G, Desroys du Roure F, Grange J, Vital M, Le Thuaut A, Crespin-Delcourt I. Predictive factors of subsequent insulin requirement for glycemic control duringpregnancy at diagnosis of gestationaldiabetesmellitus. Int J Gynaecol Obstet 2019;144(3):265‑70.
Akinci B, Celtik A, Yener S, Yesil S. Is fasting glucose levelduring oral glucose tolerance test an indicator of the insulin need in gestational diabetes? Diabetes Res Clin Pract 2008;82(2):219‑25.
Kintiraki E, Goulis DG. Gestational diabetes mellitus: Multi-disciplinary treatment approaches. Metabolism 2018;86:91‑101.
de Valk HW, Visser GHA. Insulinduringpregnancy, labour and delivery. Best PractRes Clin Obstet Gynaecol 2011;25(1):65‑76.
Koren R, Toledano Y, Hod M. The use of insulin detemir during pregnancy: a safety evaluation. Expert Opin Drug Saf 2015;14(4):593‑9.
Koren R, Hochman Y, Koren S, Ziv-Baran T, Wiener Y. Insulin treatment of patients with gestational diabetes:does dosage play a role? J MaternFetalNeonatal Med 2020;1‑7.
Lv S, Wang J, Xu Y. Safety of insulin analogs during pregnancy:a meta-analysis. Arch Gynecol Obstet 2015;292(4):749‑56.
Senat MV, Deruelle P. Gestationaldiabetesmellitus . Gynecol Obstet Fertil 2016;44(4):244‑7.
Mukerji G, Feig DS. Pharmacological Management of Gestational Diabetes Mellitus. Drugs 2017;77(16):1723‑32.
Langer O, Yogev Y, Most O, Xenakis EMJ. Gestational diabetes: The consequences of not treating. American Journal of Obstetrics and Gynecology 2005;192(4):989‑97.
Leipold H, Worda C, Gruber CJ, Kautzky-Willer A, Husslein PW, Bancher-Todesca D. Large-for-gestational-age newborns in women with insulin-treated gestational diabetes under strict metabolic control. Wien Klin Wochenschr 2005;117(15‑16):521‑5.
Schaefer-Graf UM, Heuer R, Kilavuz O, Pandura A, Henrich W, Vetter K. Maternal obesity not maternal glucose values correlates best with high rates of fetal macrosomia in pregnancies complicated by gestational diabetes. J Perinat Med 2002;30(4):313‑21.
Van Wootten W, Turner RE. Macrosomia in neonates of mothers with gestational diabetes is associated with body mass index and previous gestational diabetes. J Am Diet Assoc 2002;102(2):241‑3.
Mitanchez D. Foetal and neonatal complications in gestational diabetes : perinatal mortality, congenital malformations, macrosomia, shoulder dystocia, birth injuries, neonatal complications. Diabetes Metab 2010;36(6):617‑27.
Piper JM. Lung maturation in diabetes in pregnancy: if and when to test. Semin Perinatol 2002;26(3):206‑9.
Becquet O, El Khabbaz F, Alberti C, Mohamed D, Blachier A, Biran V, et al. Insulin treatment of maternal diabetes mellitus and respiratory outcome in late-preterm and term singletons. BMJ Open 2015;5(6):e008192.
