Gestational Diabetes

Gestational Diabetes is high blood sugar (glucose), that occurs during pregnancy. It usually disappears after birth. This can occur at any stage of pregnancy but it is more common during the second trimester of pregnancy and third trimester.

This happens when your body is unable to produce enough insulin (a hormone that regulates blood sugar levels) to meet your additional needs during pregnancy.

Gestational diabetes can pose a risk to your baby and you during pregnancy as well as after birth. The risks are reduced if the condition can be detected early and managed well.

Who is at greatest risk for gestational diabetes?

While any woman can get gestational diabetes in pregnancy, you are at greater risk if:

• Your body mass index (BMI), is greater than 30. To calculate your BMI, use the healthy weight calculator
• You had a previous baby that weighed in at least 4.5kg (10lb) at birth
• You had gestational diabetes during a previous pregnancy
• One of your siblings or parents has diabetes
• You are either of South Asian, Black, African, African-Caribbean, or Middle Eastern descent (even if your parents were born in the UK).

These are all possible scenarios. You should have screenings for gestational diabetics during pregnancy.

Signs and symptoms of gestational Diabetes

Gestational diabetes is not known to cause symptoms.

The majority of cases can only be diagnosed when your blood sugar levels have been tested during screening for gestational diabetics.

Hyperglycemia is a condition in which blood sugar levels are too high for some women.

• increased thirst
• Not being able to urinate as often as usual
• Dry mouth
• tiredness

These symptoms can be common in pregnancy, and they are not always a sign that you have gestational diabetes. If you have any concerns about symptoms, talk to your doctor or midwife.

How gestational diabetics can impact your pregnancy?

Many women with gestational diabetics have normal pregnancies and healthy babies. But gestational diabetes can lead to many problems like:

• Your baby is growing bigger than normal – this could cause problems during delivery and increase the chances of you needing induced labor or a caesareansection
• Polyhydramnios: Too much amniotic fluid in the womb (the fluid surrounding the baby), can lead to premature labour or complications at delivery.
• Premature Birth – Giving birth before the 37th Week of Pregnancy
• Pre-eclampsia is a condition that can cause high blood pressure in pregnancy. If not treated, it can lead to complications.
• Your baby may develop low blood sugar (or yellowing of the skin or eyes) after birth. This could require hospital treatment.
• The death of your baby ( stillbirth ) – although this is uncommon

You are at higher risk for developing type II diabetes in your future if you have gestational diabetes.

Screening for gestational diabetics

Your first antenatal visit (also known as a booking appointment) will take place at week 8-12 of your pregnancy. It is during this time that your doctor or midwife will ask you questions to determine if you are at increased risk for gestational diabetes.

A screening test should be given to anyone who has 1 or more risk factors of gestational diabetes. It takes approximately 2 hours to complete the screening test, which is known as an oral glucose tolerance test (OGTT).

This involves a blood testing at the beginning of the day, after you haven’t had any food or drinks for 8 to 10hrs (though water is usually allowed, but you should check with the hospital if in doubt). The glucose drink is then given to you. After 2 hours of rest, another blood sample will be taken to determine how your body handles glucose.

When you are between 24 and 28 weeks of pregnancy, the OGTT will be done. If you have had gestational diabetes in the past, you will be offered an OGTT sooner than usual. The second OGTT will be at 24 to 28 week if it is not normal.

Long-term effects from gestational diabetes

Normally, gestational diabetes disappears after giving birth. However, women who have it are more likely than others to develop it.

• In future pregnancies, gestational diabetes will again be an issue
• Type 2 Diabetes – A lifelong type

A blood test should be done to determine if you have diabetes. This should be done 6 to 13 weeks after your baby is born. If the result is not normal, it should be done once a year.

If you experience high blood sugar symptoms such as dry mouth, increased thirst or need to pee more frequently than usual, consult your GP immediately. Even if you feel fine, it is important to have the tests. Many people with diabetes don’t have any symptoms.

Additionally, you will be given advice about ways to lower your chance of developing diabetes. This includes maintaining a healthy weight and eating a healthy diet, as well as exercising regularly.

Research suggests that babies born to mothers with gestational diabetes might be more likely later in life to develop diabetes or become obese.

Planning future pregnancies

If you have had gestational diabetes in the past and are planning to become pregnant, you should get tested for it. This can be done by your GP.

Diabetes pre-conception clinics should be referred to anyone who has diabetes. This will ensure that your condition is under control before you can get pregnant. Talk to your GP if you are having an unplanned pregnancy.

If you are positive for diabetes, your pregnancy screening will be done sooner than usual (soon after you have had your first midwife appointment). You’ll also be offered a second test at 24 to 28 week if the results of the first test are normal.

Your doctor or midwife may also suggest that you test your blood sugar levels using a finger-pricking instrument in the same manner as during gestational diabetes.

Treatments for gestational diabetics

Controlling your blood sugar can help reduce the likelihood of problems during pregnancy if you have gestational diabetic. A blood sugar monitoring kit will be provided to you so that you can track the effects of treatment.

You can reduce blood sugar by changing your diet or exercising more. If these changes do not reduce your blood sugar enough, you may need to take medication. These could be insulin injections or tablets. Your pregnancy and birth will be closely monitored to ensure that you are not experiencing any problems.

It is best to give birth before 41 weeks if you have gestational diabetic. If labour doesn’t start naturally, it may be advisable to induce labour or have a caesarean. If you have concerns about your baby’s health, or if you are having trouble controlling your blood sugar, it may be a good idea to deliver earlier.

You will also need to be closely monitored during pregnancy, labour and delivery to ensure that you are receiving the best possible treatment and to identify any potential problems.

Checking your blood sugar level

A testing kit will be provided to you for checking your blood sugar levels. It involves using a finger-pricking tool and placing a drop of blood onto a strip.

We’ll advise you:

• How to correctly test your blood sugar
• When and how often you should test your blood sugar. Most women with gestational diabetics are advised to test their blood sugar before and after breakfast.
• What level should you aim for? This will be measured in millimoles glucose per litre (mmol/l).

A healthy diet helps in controling gestational diabetics

You can control your blood sugar by making changes to your diet, a dietitian should be referred to you. They can offer advice on your diet and help you plan healthy meals.

Also it may be recommended to:

• Eat regularly, usually 3 meals per day. Avoid skipping meals
• You can eat starchy and low-glycaemicindex (GI) foods with slow release of sugar – like wholewheat pasta and brown rice, as well as all-bran cereals and pulses, beans and lentils, muesli, and plain porridge
• Eat lots of fruits and vegetables. Try to eat at least five portions per day
• Avoid sugary foods. You don’t have to eat sugarless. However, you can swap biscuits and cakes for healthier options like fruit, nuts, and seeds.
• Avoid sugary drinks. Diet or sugar-free drinks will be better than the sugary ones. Juices, smoothies, and other “no added sugar” drinks can be high in sugar. Check the nutrition label and ask your doctor.
• Eat lean protein sources such as fish

It is also important to know foods that should be avoided during pregnancy. This includes certain types of cheese and fish.

Exercise

Regular exercise lowers blood glucose levels, making it an effective method to manage gestational diabetics. We will advise you on safe ways to exercise while pregnant. Learn more about exercise during pregnancy. Common advice is to aim for 150 minutes (two hours and thirty minutes) of moderate intensity activity per week. Strength exercises can also be done on two or more days per week.

Medicine for gestational diabetics

If your blood sugar levels persist after you have changed your diet and exercise regularly, or if they are very high, you may need to be prescribed medicine. These may include insulin injections or tablets, usually metformin. As your pregnancy progresses, blood sugar levels may rise. You might need to take medication later on. These medicines can generally be stopped after birth.

Tablets gestational diabetics

Metformin can be taken in a tablet as often as 3 times daily, usually after or with meals.

Side effects of metformin include:

• feeling sick
• being sick
• stomach cramps
• diarrhoea
• Appetite loss

Sometimes, a different tablet called Glibenclamide might be prescribed.

Insulin injections gestational diabetics

Insulin might be recommended when:

• Metformin is not safe for you or causes side effects.
• Metformin can’t control your blood sugar levels
• You have extremely high blood sugar
• Your baby is too large or fluidy in your womb

Insulin can be taken as an injection. You’ll learn how to do it yourself. You may have to inject insulin before meals, bedtime, and on waking depending on which type of insulin you are prescribed.

The amount of insulin you should take will be explained to you. Your insulin dose will be adjusted as your pregnancy progresses. Hypoglycaemia can be caused by insulin. Low blood sugar can cause you to feel shaky and sweaty, become hungry, turn pale, or have trouble concentrating.

If you notice this, it is important to test your blood sugar and treat it immediately if it is low. Learn how to manage low blood sugar. If you are prescribed insulin, you will be provided with information on hypoglycaemia.

Monitoring your pregnancy

Gestational diabetes may increase your baby’s risk of developing health problems such as larger breasts or more severe complications. This is why you will be offered additional antenatal appointments to monitor your baby.

You should offer these appointments:

• An ultrasound test is done at week 18-20 of your pregnancy to examine your baby for any abnormalities.
• Ultrasound scans at weeks 28, 32, and 36 are used to monitor the growth of your baby and check for amniotic fluid levels. Regular checks begin at week 38.

Giving birth

If you have gestational diabetics, the ideal time to give birth is typically between weeks 38 and 40. You may be able wait to have labor naturally if your blood sugar levels are within normal limits and you don’t have any concerns.

If you are not due within 40 weeks or 6 days, however, you will usually be offered Induction of Labour or a Caesarean Section. If you have concerns about your baby’s health or if your blood sugar is not well controlled, it may be a good idea to deliver earlier.

It is important to give birth in a hospital with specially trained healthcare professionals who can provide the best possible care for your baby. Take your blood sugar testing kit and any medications with you to hospital when you give birth. You should continue to test your blood sugar and take your medications until you are in established labor.

Doctors will monitor your blood sugar levels closely  during labor and delivery, to control your blood sugar, and to do so you may need insulin administered by drip.

After birth

You can see, hold and feed your baby as soon as possible after giving birth, because he needs to eat within 30 minutes after he was born. Then, you should continue to feed your baby at regular intervals (every 2 hours), until your baby’s blood sugar levels stabilize.

The baby’s blood sugar level is checked within 2 to 4 hours of birth. Your baby might need to be fed via tube or drip temporarily if his sugar level is low. A specialist neonatal unit may be able to look after your baby if they are unwell or require close monitoring.

Mostly you will stop most medications that you take to manage your blood sugar levelsafter giving birth. Usually,  your doctos will ask you to continue monitoring your blood sugar for at least 1 to 2 days after giving birth. You and your baby can usually go home if you are both healthy.

You should do a blood test to determine if you have diabetes six to thirteen weeks after giving birth. Because a small percentage of women with gestational diabetics have continued to raise blood sugar levels after giving birth,

A normal result will usually mean that you should have an annual diabetes test. If you have had gestational diabetes, you are at higher risk of developing type2 diabetes, a long-term type of diabetes.