Diabetes is a medical condition with higher-than-normal glucose (sugar) levels. Gestational Diabetes (GDM) is diabetes that develops in pregnancy and usually goes away after birth. GDM is common, affecting about 10 in every 100 pregnancies. It is usually detected around 26-28 weeks, but if you had GDM in a previous pregnancy, it may be diagnosed much earlier in subsequent pregnancies. Most women and patients with GDM will have healthy pregnancies and healthy babies.
In pregnancy your body makes high levels of pregnancy hormones which reduces the effect of insulin, the main hormone that controls glucose levels. If your body cannot make enough insulin or use this insulin effectively, then blood glucose rises and often causes diabetes.
When we eat, our body breaks down carbohydrates (starchy food such as pasta, rice and bread, natural sugars and processed sugars) into glucose. Glucose then enters the bloodstream.
Insulin is needed to move glucose from the blood into individual cells, where it is mainly used for energy. Without enough insulin, the cells in our body cannot absorb enough glucose. It also means the glucose remains in our blood stream causing higher blood glucose levels (which we can measure as a sign of diabetes).
You may be at risk of developing gestational diabetes if:
Higher glucose levels in your blood can mean more glucose transfers to your baby, and this can affect your baby’s health
With good control of your blood glucose levels, you are more likely to enjoy a healthy pregnancy and give birth to a healthy baby. Once you know are diagnosed with GDM you will be referred by your midwife to the diabetes pregnancy doctors and midwives and also signposted to useful web pages and information. It’s important to visit these resources as soon as possible and before your first diabetes appointment because they have lots of useful explanations, treatment descriptions and learning to help you and your baby. These include information on how to monitor your blood glucose and immediate steps you can take to help control your glucose levels. Before your appointment with the diabetes team (usually the diabetes midwife) you may want to consider any further questions you still have before attending.
The Diabetes UK website (link here) provides information on Gestational Diabetes, treatments including healthy diet, lifestyle changes, complications of diabetes and what care to expect.
The Royal College of Obstetricians and Gynaecology provides information on how GDM can affect you and your baby and is available here.
Treatments
We recommend you follow the treatments below to maintain good glucose control and to help to avoid complications in pregnancy associated with diabetes.
While healthy eating and increasing activity is recommended during and before pregnancy for everyone, once you know you have GDM you can immediately start healthy eating and increasing activity levels. As soon as you are diagnosed with GDM, there are important steps you can take immediately to reduce the risk for you and your baby. Diabetes UK provide further information on diet in GDM that can be accessed here and includes meal and snack ideas for you to consider. Please visit this as soon as possible as this will help you to understand and make important changes to your diet. You can be referred to a dietitian who will discuss your diet and calorie intake and provide any support you need. If you are finding it difficult to understand the information or make the changes, please reach out to your diabetes midwife.
Maintaining a healthy lifestyle can help you maintain control of your blood glucose. You can find information about safe and effective exercise in pregnancy here and then consider a level of exercise that is appropriate for you.
Your diabetes team will show you how to check your blood glucose. To start with we recommend testing six times a day to help you and your diabetes team understand how high your glucose levels are and then this information will help us decide together the best management for your GDM. It’s important that you tell your diabetes midwife if your blood glucose readings are higher than the target range, so that we can help adjust your treatment- your diabetes midwife will let you know when and hot to contact them with this information. share your blood sugars with the diabetes team via an app, this can be really helpful in supporting your diabetes journey.
Often diet and healthy lifestyle will be enough to control your blood glucose, but if they remain high, then you may be advised to start medication. Decisions about treatment will be made in partnership between you and your team. It’s important that you understand the benefits and risks of any treatment option.
Metformin tablets (Usually modified release- which means they release slowly into your body) tablets are safe to take in pregnancy. Metformin reduces the amount of glucose produced by your liver and makes insulin work more effectively. It’s taken with or after a meal. Although metformin is unlicenced for use in pregnancy it has been used frequently for many years and is recommended as safe by NICE and other leading clinical expert and national organisations. The BUMPS website listed below gives more information on safety of medication in pregnancy.
Insulin is safe to take in pregnancy. Insulin is a hormone that allows glucose to enter the cells for energy. It can only be taken by injection using a very small needle that goes in just under the skin.
Your local team will discuss care options with you and explain how you can give yourself insulin if it is needed. For more information on treatments click here
Your local team will discuss your birth options with you. This includes waiting for labour to start naturally, induction of labour or having a planned caesarean birth. This will depend on your individual details and preferences and decisions will be made in partnership with you. During labour we recommend monitoring of your blood glucose levels. Occasionally additional treatment is required to help keep these in range.
Your baby will stay with you unless they need extra care or require care on the neonatal unit. If they are with you then we would recommend having skin to skin contact with baby and advise for baby to have their blood sugar tested a few hours after birth to make sure it is normal. Further glucose testing is recommended for your baby and we normally we recommend you and your baby remain in hospital for the first 24 hours.
GDM usually goes away after your birth. We recommend a glucose test before going home to make sure your glucose levels are now normal. Afterwards we recommend a further glucose test (HbA1c) about 12 weeks after your birth and annually thereafter. This is done with your GP who will check the results and discuss with you if needed.
IMPORTANT After your birth - - we strongly recommend you continue to follow advice on healthy diet and lifestyle to reduce the risk of developing Type 2 Diabetes. Up to fifty percent of women and patients who have had GDM will develop Type 2 Diabetes. A healthy diet and lifestyle is also recommended for your baby when they start eating solid foods (and of course your partner too).
To reduce the risk of developing diabetes you can also refer yourself to the local diabetes prevention programme. This is run by the local Healthier You service and is accessible here:
NHS England » Healthier You: NHS Diabetes Prevention Programme Gestational Diabetes Mellitus (GDM)
You can register while you are pregnant and join or will be contacted about the programme about one month after you have had your baby. Further information on the diabetes prevention programme can be found here and from this QR code
Royals College of Obstetricians and Gynaecology Link (here)
Diabetes UK (here)
Your guide to Gestational Diabetes- Diabetes UK (here)
NHS Choices (here)
Best use of medicine in pregnancy site BUMPS
