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Gestational diabetes (diabetes in pregnancy)

Gestational diabetes is a type of diabetes that some women develop when they are pregnant. If you have gestational diabetes, your blood sugar (glucose) levels are higher than normal. It can lead to problems for you and your baby if the diabetes is uncontrolled. However, there are many treatment options that can help control the condition during your pregnancy and reduce the risks to you and your baby

Gestational diabetes means you have a high blood sugar level that develops during pregnancy. The condition usually resolves after the birth of your baby. Around twenty two in 100 pregnancies are affected by gestational diabetes.

Normally, your body produces a hormone (a chemical messenger carried in your blood) called insulin to control the sugar level in your blood. Insulin causes the sugar in your blood to be taken up by your cells and stored to be later turned into energy.

During pregnancy, your hormones, such as oestrogen and progesterone, cause your cells to become less sensitive to insulin. This means your body needs to produce more insulin than normal to control your blood sugar. If you develop diabetes in pregnancy, it means that either your body isn’t releasing enough insulin, or your cells aren’t responding to it. The result is that your blood sugar level remains high. This can have a number of effects on you and your growing baby.

Gestational diabetes usually begins in the second trimester (after 13 weeks) of pregnancy. The condition often resolves after the birth of your baby. If you still have diabetes after your baby is born, it’s likely that you already had diabetes before you became pregnant. In this situation, you will need to have treatment for the condition.

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Details

  • Symptoms Symptoms of gestational diabetes

    Symptoms of gestational diabetes are uncommon. This is because the condition is usually diagnosed from screening tests before symptoms develop. However, if diabetes isn’t detected and or treated, you may develop symptoms such as:

    • feeling thirsty more often than usual
    • needing to urinate more often
    • having infections which affect your urinary tract

     These symptoms aren’t always caused by gestational diabetes. If you notice any of these symptoms, see your doctor.

  • Diagnosis Diagnosis of gestational diabetes

    At your first antenatal appointment, your midwife will ask you a number of questions to assess your risk of gestational diabetes. Based on this, you may be offered a test later in your pregnancy to find out whether you have diabetes.

    The test for gestational diabetes involves drinking a sugary drink and then having blood samples taken. This will measure how well your body processes sugar. You will usually be offered the test if you are thought to be at risk between 24 and 28 weeks of pregnancy. It may be offered to you earlier if you have previously had gestational diabetes.

  • Treatment Treatment of gestational diabetes

    If you’re diagnosed with diabetes, you should be offered an appointment with a joint diabetes and antenatal clinic. The doctors and nurses here will be experienced in looking after pregnant women with diabetes. You will have more frequent antenatal appointments than women who don't have gestational diabetes.

    Your treatment will be aimed at keeping your blood sugar lowered enough to help prevent complications. You will need to regularly test your blood sugar level. You will be given advice on how to test it, how often, and the level that you're aiming for.

    Self-help

    Your doctor or dietitian will advise you on ways to manage your gestational diabetes with diet and exercise changes. This may be all you need to do to keep your blood sugar level low enough to help prevent complications.

    The following healthy eating ideas could help to keep your blood sugar level stable and within the ideal range.

    • Try to eat carbohydrates that release their energy slowly. Examples of these include cereals, wholemeal bread, pasta and potatoes.
    • Eat a variety of lean meat and fish.
    • Aim to eat up to (but not more than) two portions of oily fish each week, such as mackerel, sardines and salmon.
    • Try to eat at least five portions of fruit and vegetables every day.
    • Limit the amount of high sugar, salt and fatty food that you eat. An easy way to reduce the amount of sugar in your diet is to replace fizzy drinks and squashes with sugar-free versions. You could also try using herbs and spices to flavour your food, instead of using salt.
    • When cooking, aim to use unsaturated fats or oils such as olive oil and rapeseed oil instead of butter.

    Keeping active during pregnancy can reduce your risk of developing gestational diabetes. Speak to your doctor or midwife if you have any concerns about exercising during pregnancy, or if you haven’t previously been doing any.

    Medicines

    Between one and two in 10 women won't be able to control their diabetes with lifestyle changes and will need medication. Your doctor will discuss different treatment options with you if you’re unable to control your diabetes after one to two weeks of diet and exercise changes.

    You may be prescribed insulin, which you will need to take as an injection. You will be shown how to inject yourself and get advice on when to do this. Many tablet treatments for diabetes aren’t recommended during pregnancy. However, you may be prescribed metformin or glibenclamide which work in different ways to reduce the level of sugar in your blood.

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  • Causes Causes of gestational diabetes

    There are a number of factors that can increase your risk of developing gestational diabetes. You’re more at risk if you:

    • are overweight or obese
    • have previously given birth to a large baby weighing 4.5kg or more
    • had gestational diabetes in a previous pregnancy
    • have a close relative with diabetes, such as a parent, brother or sister
    • have polycystic ovary syndrome

    Your ethnic group may also increase your risk of getting gestational diabetes. The condition is more common in people with a South Asian (particularly India, Pakistan or Bangladesh), black Caribbean or Middle Eastern background.

  • Complications Complications of gestational diabetes

    Gestational diabetes can lead to a number of complications for you or your baby if it isn’t controlled. However, you can reduce your risk of many of these by carefully controlling your blood sugar level.

    Complications affecting you

    Complications that can affect you include the following.

    • Pre-eclampsia – You may develop dangerously high blood pressure during your pregnancy. Your doctor or midwife will measure your blood pressure to check for this. Severe headaches, swelling of the feet, ankles, face or hands, altered vision and abdominal (tummy) discomfort can all be symptoms of pre-eclampsia. If you have any of these symptoms, see your doctor or midwife immediately. If left untreated, you may develop a more serious condition called eclampsia. This can lead to serious complications and may even be fatal.
    • Too much amniotic fluid (the fluid around your baby in your womb). Having too much fluid around your baby can increase your risk of premature labour. This could also be a sign that your baby is in the wrong position for birth. If you have any discomfort in your abdomen, see your doctor or midwife for advice.
    • Premature labour – giving birth before 37 weeks of pregnancy.
    • Difficulties giving birth naturally. This is because your baby may grow larger than normal if you have diabetes during pregnancy. This means that you could need a caesarean.

    You're also more likely to develop gestational diabetes in future pregnancies and have a higher risk of developing type 2 diabetes later in life. After you’ve had your baby, you should be checked for type 2 diabetes regularly so that treatment can be started if you need it.

    Complications affecting your baby

    Complications that may affect your baby include the following. Remember that your midwives and doctor will monitor you throughout your pregnancy and birth to reduce any risks to you and your baby.

    • Your baby can grow larger than normal. This can make labour and birth more difficult, and can increase the risk of shoulder dystocia (where your baby’s shoulders get stuck during birth). Your midwife or doctor will advise you on the best way for your baby to be born safely.
    • Your baby may have low blood sugar (hypoglycaemia) after birth. This will be monitored and only needs treating if your baby’s blood sugar drops below a certain level.
    • Your baby has a slightly higher risk of developing jaundice. This is a common condition in newborn babies that can cause your baby’s skin and eyes to have a yellow tinge. This will fade over a couple of weeks and doesn’t usually need treatment.
    • If born prematurely, there is a higher chance of your baby having respiratory distress syndrome. This is when your baby’s lungs haven’t fully developed at the time of birth. This can lead to serious complications for your baby, but he or she will be closely monitored to minimise their risk of these complications.
    • Your son or daughter will have a higher risk of being obese in later life.
    • Your child will also have a risk of developing type 2 diabetes when he or she is older.
  • After your baby is born After your baby is born

    You and your baby will have your blood sugar levels tested shortly after delivery, to make sure these are back to normal.

    Doctors recommend that it's best to breastfeed your baby soon after birth to keep your baby's blood sugar at a safe level.

    You can usually stop taking medication for the condition immediately after birth. You will need to have a blood sugar test at your six-week check-up to ensure that your blood sugar has returned to the expected level. It’s important to keep your blood sugar level under control. Make sure that you make an appointment to get it checked once a year.

    There is a chance that your blood sugar levels could remain high after the birth of your baby. This means that you could develop diabetes, even though you’re no longer pregnant. If you have high blood sugar after childbirth, your doctor will talk to you about some options to manage the condition.

  • FAQs FAQs

    How long will it take for the gestational diabetes to go away once my baby is born?

    Answer

    For most women, once their baby is born, their gestational diabetes goes away. If you were prescribed any medicines for diabetes that developed during pregnancy, you will be able to stop taking these immediately after delivery.

    Explanation

    Your blood sugar will be tested soon after the birth of your baby and then again at your six-week postnatal check-up. If you didn’t have diabetes before you were pregnant, you will usually be advised to stop medication immediately following the birth of your baby. You will still be advised to make changes to your diet and lifestyle. This is because you have a greater risk of developing type 2 diabetes once you‘ve had gestational diabetes.

    More than a third of women with gestational diabetes will go on to develop type 2 diabetes within 10 years. You can reduce your risk of developing type 2 diabetes by being changing your lifestyle. Being active, eating a balanced diet and maintaining a healthy weight can help to prevent you from developing type 2 diabetes.

    How will gestational diabetes affect the birth of my baby?

    Answer

    If your diabetes is well controlled it’s likely that your baby’s birth won’t be affected by you having gestational diabetes. However, for a number of reasons, you may be more likely to need a caesarean. You will be able to discuss your options at your antenatal appointments.

    Explanation

    If you have gestational diabetes, you will usually be offered to have your labour induced or have a caesarean after 38 weeks.

    Your doctor will discuss an individualised birthing plan with you, depending on any special requirements you may have. Your doctor will advise you to have your baby in a hospital that has a team who are experienced in looking after women who have diabetes and their babies. Home births aren’t recommended for women who have gestational diabetes. If you have any questions about your delivery, speak to your doctor or midwife.

    You may need an intravenous drip (a tube put into a vein in your arm) during labour. This will ensure that you can be given insulin and sugar solution to ensure your blood sugar level remains within the correct range throughout labour. Your doctor will discuss your treatment options with you beforehand, in preparation for your delivery.

    Your baby will be continuously monitored throughout your labour to make sure he or she is being born safely.

    What is hypoglycaemia?

    Answer

    There is a chance that you could develop very low levels of blood sugar during pregnancy. This is known as hypoglycaemia. Your doctor or specialist nurse will explain how to recognise the symptoms of hypoglycaemia, and what to do if it happens.

    Explanation

    If you take too much of your medicines or miss a meal, you may develop very low levels of blood sugar. This is called hypoglycaemia (or a 'hypo').

    Symptoms of hypoglycaemia, can include:

    • being pale
    • having a faster heart beat than usual
    • sweating
    • feeling confused

    Your doctor or specialist nurse will explain how to recognise the symptoms of hypoglycaemia, and what to do if it happens. Keeping a sugary, soft drink with you is a good idea so that you can drink this if you start noticing signs of hypoglycaemia.

  • Resources Resources

    Further information

    Sources

    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press; 2010: 826, 828 ̶ 29, 1098
    • Diabetes. The World Health Organization. www.who.int, reviewed October 2013
    • Diabetes in pregnancy. Management of diabetes and its complications from pre-conception to the postnatal period. National Institute for Heath and Care Excellence (NICE), 2008. www.nice.org.uk
    • Dunning T. Care for people with diabetes: A manual of nursing practice. Chichester, UK: Wiley Blackwell, 2009
    • What is diabetes? Diabetes UK. www.diabetes.org.uk, accessed 16 October 2013
    • Setji T, Brown A, Feinglos M. Gestational Diabetes Mellitus. Clinical Diabetes 2005; 23(1):17 ̶ 24. doi:10.2337/diaclin.23.1.17
    • Gestational diabetes mellitus. BMJ Best Practice. www.bestpractice.bmj.com, published 8 April 2013
    • Screening and diagnosing gestational diabetes mellitus. Agency for Healthcare Research and Quality, 2012 www.effectivehealthcare.ahrq.gov
    • Diabetes in pregnancy. Map of Medicine. www.mapofmedicine.com, published 8 July 2013
    • Preeclampsia. Medscape. www.medscape.com, published 16 September 2013
    • Hypertension in pregnancy. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published November 2010
    • Stroke. Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). National Institute for Health and Care Excellence (NICE), 2008. www.nice.org.uk
    • Arulkumaran S, Regan R, Papageorghiou A, et al. Oxford Desk Reference: Obstetrics and Gynaecology. New York: Oxford University Press; 2011
    • Neonatal jaundice. Medscape. www.medscape.com, published 21 June 2012
    • Blackburn ST. Maternal, Fetal, and Neonatal Physiology: A clinical perspective. 4th ed. Philadelphia, USA: Elsevier; 2012
    • Respiratory distress syndrome. Medscape. www.medscape.com, published 18 September 2012
    • Management of diabetes. Scottish Intercollegiate Guidelines Network (SIGN), 2010. www.sign.ac.uk
    • Healthy eating and herbal supplements. Diabetes UK. www.diabetes.org.uk, accessed 3 October 2013
    • Gestational diabetes. Patient Plus. www.patient.co.uk , published May 2013
    • Joint Formulary Committee. British National Formulary (online). London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 22 October 2013 (online version)
    • Hypoglycaemia. Diabetes UK. www.diabetes.org.uk, accessed 3 October 2013
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    Reviewed by Hemali Parekh, Bupa Health Information Team, December 2013.

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