Dr Karen Joash, Consultant Obstetrician and Gynaecologist at The Portland Hospital, explains everything you need to know about gestational diabetes.
Gestational diabetes is when women develop a form of diabetes when they’re pregnant. While this can be a daunting prospect, I assure my patients that the vast majority of women will return to normal after giving birth. This is aided by a careful diet and planned exercise.
Gestational diabetes can develop during pregnancy as the placenta produces hormones called human placental lactogen (HPL), which inhibits the body’s ability to produce insulin. Without enough insulin – which is the hormone responsible for helping your body absorb glucose or ‘sugar’ – glucose will accumulate in your bloodstream causing your blood sugar levels to skyrocket.
Am I at risk?
Some women are at a higher risk of developing gestational diabetes than others and if you have certain characteristics you should consult your doctor or obstetrician about it. Women who should be particularly aware include those with a high body mass index (BMI), those who have delivered babies weighing in excess of 4kg in the past, and women with immediate family members with Type 2 diabetes, or indeed those who have had gestational diabetes before. Studies have also shown that women of Asian, African-Caribbean or Middle Eastern origin can also be at higher risk.
During your ultrasound scans, if your clinician identifies a large amount of fluid around the baby, it is likely your baby will be born with a large birth weight and you may also be monitored for signs of the condition.
If your doctor suspects you might be at a high risk of developing gestational diabetes, you will be offered a glucose tolerance test to identify whether you are affected by the condition between 24 and 28 weeks gestation. This involves taking two blood tests: the first after a short period of fasting overnight and the second, around two hours later to monitor how your body reacts to glucose.
While your midwife or doctor will identify your risk of developing gestational diabetes at your first appointment, the condition does not usually manifest until about halfway through your pregnancy. Women who develop gestational diabetes might not notice any changes to their bodies, however the symptoms you might notice include fatigue, increased thirst or a repeated bout of urinary tract infections.
What does this mean for my baby?
Throughout your pregnancy you will be required to reduce your sugar consumption and eat a healthy, balanced diet to manage your blood sugar levels; although I do recommend that all mothers-to-be try to follow a healthy diet where they can to help give you and the little one the best start.
Your doctor or midwife will work with you to help explore ways to transform your diet, however if you are unable to control your blood sugar levels effectively, you may also be given insulin injections or tablets to assist.
Gestational diabetes can affect your baby by increasing her production of insulin, which can lead to an increased birth weight or a higher risk of jaundice. However you can be reassured that these conditions rarely result in serious health issues.
If your baby is large or you are on medication to control your blood sugar it may be necessary to induce labour at around 37 to 38 weeks, to avoid potential complications. Your doctor may also suggest a c-section at this stage.
Patients should also be aware of the risk of their baby developing a condition called hypoglycemia, which is when your baby is born with low blood sugar levels. You will be encouraged to feed your baby as early as possible and your baby will need a heel prick test to ensure the sugar levels are not too low. In the event where this is the case, your baby may require a formula feed to stabilise her blood sugar levels.
Should I be worried?
The large majority of women who have gestational diabetes deliver healthy, happy babies and with a healthy diet you should have no reason to worry.
Identifying the condition early and managing it throughout the pregnancy will help to reduce the risk of any problems for you and your baby during pregnancy and childbirth.
Some babies who grow very large because of high blood sugar coming from the mother are at an increased risk of a complication called shoulder dystocia where the head is delivered and the shoulders become stuck due to the size. You may be offered an induction of labour from 37 weeks or earlier if your baby is felt to be at risk. In some cases a caesarean may be offered.
What are the long-term consequences?
Those experiencing gestational diabetes are often glad to hear that it is usually a temporary condition, disappearing once you have given birth. Treatment is no longer required once you have welcomed your bundle of joy into the world.
However it is important to be aware that gestational diabetes does increase your risk of developing diabetes at a later stage of life, so women with gestational diabetes should be monitored and take simple steps to reduce their chances of developing the condition later on. This requires living a healthy lifestyle with a low sugar intake and having blood sugar checks in the weeks following your delivery, and on an annual basis with your GP from then on. Keeping fit and at the ideal weight also reduces your risk.
If you are at all worried about managing gestational diabetes, I recommend speaking with a health professional who will assess you and provide you with all the advice you need to manage the condition and welcome a healthy baby when the time comes.
What if I already suffer from diabetes?
If you already suffer from Type 1 or Type 2 diabetes, it is advised that you visit a specialist health professional and work with them to ensure your blood sugar levels are controlled before you conceive and during pregnancy. While the symptoms and management techniques are relatively similar to those of gestational diabetes, you will be at a higher
risk of experiencing complications during your pregnancy and should be monitored more closely.