Using a question-and-answer format, we present some of the discoveries and findings we made, and add the hypotheses we elaborated and the research fields we will continue to explore:
It seems that women with higher blood glucose levels in early pregnancy have a higher risk of metabolic and cardiovascular adverse outcomes in the postpartum period than women with gestational diabetes diagnosed in the second trimester.
Women diagnosed with gestational diabetes without classical risk factors also have a high risk of maternal and neonatal complications during pregnancy and delivery as well as to develop pre-diabetes or type 2 diabetes. However, those risks are even higher with increasing number of classical risk factors such as obesity, family history of diabetes and high-risk ethnicity.
We have been able to show that depression is not related to a woman's initial weight in pregnancy. However, it does play a role in weight gain during pregnancy. Depression does not increase the need for medication lowering blood sugar, nor does the use of these medications have a deleterious effect on depression.
Life events during pregnancy as well as symptoms of stress, depression and anxiety are associated with fasting glucose in pregnant women, thus representing important risk factors for the development of gestational diabetes. In women with gestational diabetes, life events during pregnancy as well as symptoms of stress, depression and anxiety also have a negative impact on obstetric and neonatal outcomes.
Our research has shown that women with higher intuitive eating scores i.e. eat in response to physiological signs of hunger and satiety have improved body weight and glycemic control during pregnancy and in the postpartum period compared to women with lower scores of intuitive eating.
More than 50% of our patients are diagnosed with increased fasting glucose. The timing and quality/quantity of the last food intake in the evening, the quality of sleep or the frequency of awakenings, are explored with the aim to explain these observations.
In our clinic, approximately 15% of our patients have experienced an episode of hypoglycemia following postpartum induced hyperglycemia, mostly without symptoms. Surprisingly, women with hypoglycemia have a more favorable metabolic profile.
We have been able to show that in gestational diabetes, pre-pregnancy body mass index, weight gain during pregnancy and the need for medical treatment are essential maternal predictors of neonatal complications. However, fetal anthropometric parameters during the third trimester can help us to predict neonatal complications, independently of maternal parameters. Thus, personalized management of women with gestational diabetes, based on these maternal and fetal predictors, may help to reduce neonatal complications in the future.
Gestational diabetes is associated with an increased risk of developing certain metabolic complications after pregnancy, such as glucose intolerance, obesity, metabolic syndrome and even cardiovascular events. In this context, we are evaluating the cardiovascular and metabolic health of women treated at the CHUV for gestational diabetes up to one year postpartum.
What is better: Fasting glucose? Oral glucose tolerance tests using 75 grams of sugar? Overall glucose control using HbA1c? Each test has its strengths and weaknesses and we identify which test is the best method to assess the current and future risk of diabetes at different times after delivery. What clearly emerges from our observations and the relatively low sensitivity of all tests in the early postpartum is that not only should a woman be tested a few months after delivery, but also that testing should be continued for one year postpartum and beyond to assess the risk of diabetes.
In women with a history of gestational diabetes, weight retention after birth is associated with an increased risk of developing type 2 diabetes in the future. Overall, we observed that weight after 6-8 weeks postpartum decreases only slightly. In order to provide prevention strategies, we aim to identify elements that could predict this weight retention and how to minimize it.