Here at ObGyn Matters, we have a number of specialist Obstetricians with vast experience in the management of medical conditions in pregnancy. We want you to feel confident and knowledgeable managing your own condition, so we have put together this information pack to help!

What is gestational diabetes?

Diabetes that develops during pregnancy is known as gestational diabetes. It happens because your body cannot produce enough insulin (a hormone that helps to control blood glucose) to meet the extra needs of pregnancy. This results in high blood sugar levels (blood glucose). Gestational diabetes usually starts in the middle or towards the end of pregnancy.

How common is gestational diabetes?

Gestational diabetes is common. It affects at least 5-6 in 100 women during pregnancy. You are more likely to develop gestational diabetes if you have any of the following risk factors:

• your body mass index (BMI) is higher than 30

• you have previously given birth to a baby weighing 4.5 kg (10 lbs) or more

• you have had gestational diabetes before

• you have a parent, brother or sister with diabetes

• your family origin is South Asian, Chinese, African-Caribbean or Middle Eastern

How will I be checked for gestational diabetes?

The test to confirm gestational diabetes is called Glucose Tolerance Test(GTT)

This is a blood test.

It is usually done between 24 and 28 weeks pregnant.

A GTT involves fasting overnight (not eating or drinking anything apart from water):

• In the morning you will have a blood test before you eat or drink anything( except water)

You are then given a glucose drink.  The blood test is repeated 2 hours later to see how your body reacts to the glucose drink.

If you have had GDM in a previous pregnancy you will be sent an appointment for an early OGTT. If this is normal, you will be sent another appointment for a repeat OGTT at 24-27weeks.

During your routine pregnancy care, your urine is tested for glucose. If glucose is present in your urine, then your healthcare team may recommend that you have a GTT.

NICE clinical guidelines state that GDM is diagnosed if OGTT:

• fasting plasma glucose level of 5.6mmol/l or above.

• or a 2 hour plasma glucose level of 7.8mmol/l or above.

What if I have gestational Diabetes?

Most women who develop gestational diabetes have healthy pregnancies and healthy babies but occasionally gestational diabetes can cause serious problems, especially if it is not well controlled. If your blood glucose levels are high, the chances of you having an induced labour or a caesarean birth are increased.

The risks to your baby are:

• The most common problem associated with GDM is your baby growing too big in your uterus (womb). This is called macrosomia. This is because the growing baby is receiving too much glucose via your placenta. This may cause problems with delivery as the baby grows too large to deliver safely through the vagina. This will mean that your baby may need to be delivered by caesarean section

• shoulder dystocia (where your baby’s shoulder gets stuck during birth)

• stillbirth or the baby dying at or around the time of birth. This is uncommon.

• needing additional care once they have been born, possibly in a neonatal unit • being at greater risk of developing obesity and developing type 2 diabetes in later life.

Controlling your levels of blood glucose during pregnancy and labour reduces the chances of these complications for you and your baby

Monitoring your blood glucose

After you have been diagnosed with gestational diabetes, You are required to blood glucose monitor at least 4 times per day to check blood glucose levels. You are required to monitor pre breakfast, 1 hour post breakfast, 1 hour post lunch and 1 hour post evening meal.

Healthy eating and exercise

The most important treatment for gestational diabetes is a healthy eating plan and exercising regularly. Walking for 30 minutes after a meal can help with controlling your blood glucose levels. Gestational diabetes usually improves with these changes.

Medications- These are required if diet & exercise in not enough to control the blood sugar.

Metformin (tablet)

This helps your own insulin to work more effectively, thus reducing some of the insulin resistance associated with pregnancy hormones. It is considered safe in pregnancy. Metformin occasionally may cause side effects (heartburn, nausea, flatulence) but these effects are lessened if you take the tablet with the first mouthful of food as instructed by the doctor.

Insulin (injection)

You may need additional insulin to control your blood glucose levels. This has to be given by injection into the skin. This is also safe to be given in pregnancy.

What happens once my baby is born?

Your blood glucose should return to normal post birth. You may need advice from the Obstetrician around reducing/stopping medications.

Post delivery

Your baby’s blood glucose will need to be monitored post-delivery for a minimum of 24 hours but you may need to stay in hospital longer. This is to check that your baby’s blood glucose is not dropping too low, this is called neonatal hypoglycaemia. Your baby will need to be fed quite soon after delivery and then 3 – 4 hourly, their blood glucose levels will checked regularly before each feed during this time.

Postnatal care

It is advised to do fasting blood glucose test 6 weeks after the delivery of your baby, and a further blood test (called the HbA1c test) 3 months after delivery to check that your blood glucose levels have returned to normal.

Having gestational diabetes increases your risk of developing diabetes later on in life; therefore it is important to continue to follow a healthy diet and lifestyle and aim to maintain a healthy weight after the birth of your baby. You should have an annual HbA1c to screen for diabetes now you have had gestational diabetes.