Gestational Diabetes

Web Resource Last Updated: 05-10-2020

Contents

What is gestational diabetes?

This is a type of diabetes that affects pregnant women, usually during the second or third trimester. In the vast majority of cases gestational diabetes disappears after the baby is born. Gestational diabetes is more common in women who are overweight but it may also develop in other situations. These include the following:

  • Having had gestational diabetes in a previous pregnancy
  • A large baby in a previous pregnancy (over 4.5 kg/10 lb)
  • An unexplained stillbirth
  • Being over 25 years old
  • A family history of diabetes
  • A previous difficult pregnancy and/or delivery

What causes gestational diabetes?

Your body produces insulin, which keeps blood glucose levels under control. During pregnancy, the body produces certain hormones that work against insulin. This means that more insulin is needed to keep the blood glucose levels normal.

If your body does not produce enough insulin to do this, your blood glucose level rises and you develop diabetes.

How is gestational diabetes diagnosed? 

Screening at first antenatal visit

At your first antenatal appointment (sometimes called a ‘booking visit’), when you are around 12 weeks pregnant, you should be assessed for the presence of risk factors for gestational diabetes.

All women have their urine tested for sugar at the antenatal clinic. If sugar is present in your urine sample, you will have to give a blood sample, which will also be tested.

If your blood test shows that your blood glucose level is high, then you will have to have a glucose tolerance test. For this, you will have to fast overnight so that any food you eat does not affect the test result (you are allowed to drink water) and then you will have a blood test. You will be given a sugary drink after the blood test and two hours later you will have another blood test.

Screening later in pregnancy 

You will have another blood test when you are around 24–28 weeks pregnant. If your blood glucose level is high, then a glucose tolerance test will be carried out.

If your blood tests show that you have gestational diabetes, you will be offered a review with the joint diabetes and antenatal clinic, which should take place within one week.

What treatment is needed?

If you have gestational diabetes, you will need regular assessment at the antenatal clinic. A team of doctors and nurses specialising in both pregnancy and diabetes will look after you. You will also see a specialist dietitian. They will be interested in how well your baby is developing and how well controlled your blood glucose is. This will help to determine when and how your baby will be delivered. The aim will be for you to have a normal delivery, but it is most likely that your baby will be born in hospital and not at home. You will be able to breastfeed your baby if you wish.

If you have diabetes when you are pregnant you can pass your high blood glucose levels onto your unborn baby. This can cause the baby to grow very big, especially around the tummy, and can lead to a difficult labour. Keeping your blood glucose under control will help to avoid this. If you smoke, you must stop immediately as the risks to you and your baby will multiply if you continue to smoke.

The amount and the type of food that you eat will affect your blood glucose levels. The dietitian will advise you about healthy eating.

Healthy eating

If you have gestational diabetes, you should follow these tips to ensure that your diet is healthy.

  • Eat regularly – three meals a day.
  • Eat a portion of high-fibre and starchy foods (bread, potatoes, cereals, rice, pasta, chapatis) at every meal.
  • Eat plenty of fruit and vegetables. There is no limit to the amount of green vegetables you can have as they do not affect your blood glucose levels. It is recommended that you have up to three portions of fresh fruit a day.
  • Avoid sweet and sugary foods.
  • Cut down on fatty foods.

The diabetes specialist nurse will show you how to test your blood glucose at home. You will be asked to do this regularly. Occasionally healthy eating on its own may not be enough to keep your blood glucose under control. If that is the case, you may need to manage your diabetes with tablets or insulin injections. If this happens, your diabetes care team will be there to give you all the help you need.

After you have had your baby 

In most women, gestational diabetes disappears after the baby is born.

All women with gestational diabetes should have a fasting glucose and Hba1c test three months after their baby is born to make sure that the diabetes has gone.

To avoid developing diabetes in the future

There is a chance that the diabetes could return if you have another pregnancy or as you get older. It is advisable to have your blood glucose checked once a year for the rest of your life to make sure that diabetes has not developed silently. In addition, you should follow these tips:

  • Keep to a healthy diet.
  • Take regular exercise.
  • Keep your weight down to the ideal weight for your height.

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