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Pregnancy and Diabetes
In pregnancy blood glucose (blood sugar) levels rise. Pregnancy makes the body need more insulin to control the levels of sugar (glucose) in the body. This results in women with diabetes to require more frequent antenatal visits, the involvement of dieticians and potentially treatments in the pregnancy
If the diabetes is not well controlled during the pregnancy this may cause harm for both you and your baby.
Therefore you will need more regular check-ups with your doctor. This will help to reduce the risks and help you to stay well and have a healthy baby.
What is gestational diabetes?
Gestational Diabetes Mellitus (GDM) is a term for diabetes which starts for the first time during pregnancy. It usually resolves soon after the woman gives birth. Reports indicate that GDM occurs in between 1 in 20 and 1 in 50 of all pregnancies. GDM usually starts in the second half of pregnancy.
The risks of having GDM for you and your baby are similar to those for mothers who have known diabetes, such as difficulties with giving birth and a higher chance of needing a caesarean section. Most women with GDM recover after the pregnancy but there is a high risk of it returning (recurrence) in any future pregnancies.
Women who have had GDM are also at increased risk of developing diabetes in the future.
Risk factors
In pregnancy blood glucose (blood sugar) levels rise. Pregnancy makes the body need more insulin to control the levels of sugar (glucose) in the body. This results in women with diabetes to require more frequent antenatal visits, the involvement of dieticians and potentially treatments in the pregnancy
If the diabetes is not well controlled during the pregnancy this may cause harm for both you and your baby.
Therefore you will need more regular check-ups with your doctor. This will help to reduce the risks and help you to stay well and have a healthy baby.
What is gestational diabetes?
Gestational Diabetes Mellitus (GDM) is a term for diabetes which starts for the first time during pregnancy. It usually resolves soon after the woman gives birth. Reports indicate that GDM occurs in between 1 in 20 and 1 in 50 of all pregnancies. GDM usually starts in the second half of pregnancy.
The risks of having GDM for you and your baby are similar to those for mothers who have known diabetes, such as difficulties with giving birth and a higher chance of needing a caesarean section. Most women with GDM recover after the pregnancy but there is a high risk of it returning (recurrence) in any future pregnancies.
Women who have had GDM are also at increased risk of developing diabetes in the future.
Risk factors
- GDM is more common for women of an older age
- Women who are overweight (BMI above 30)
- Women who smoke.
- Women who have had GDM in previous pregnancies.
- Where there has been a short time interval between pregnancies.
- Women who have had a previous unexplained stillbirth.
- Women who have had a previous baby with very high birth weight (4.5 kg or more).
- Women with an immediate family member (brother, sister or parent) with diabetes.
- Some ethnic groups (South Asian, black Caribbean and Middle Eastern).
Screening and Diagnosis
The OGTT (Oral Glucose Tolerance Test) or just GTT is routinely undertaken between 24-28 weeks (typically 28 weeks). However there are recommendations for some more at risk individuals to be offered earlier testing. The National Institute for Health Care Excellence (NICE) recommends the following:
Woman who have had GDM in a previous pregnancy should be offered early self-monitoring of blood sugar (glucose) or a two-hour 75 g GTT as soon as possible after the first antenatal appointment. This is followed by a repeat GTT at 24-28 weeks of pregnancy if the first test is normal.
Women with other risk factors (see above) should have a GTT at 24-28 weeks.
The OGTT requires a period of fasting 10-12 hours, so it is best to have appointments for screening early in the morning to minimize inconvenience. The test involves taking a controlled amount of Glucose and having your blood taken before and at 1 hour and 2 hours post ingestion.
Your results will be the blood sugar levels of the three tests.
Typically the Fasting (first) should be below 5.1mmol, the second recording level should be below 10.ommol and the third below 8.5 mmol. Please feel free to discuss your results with Dr. Petrina.
The OGTT (Oral Glucose Tolerance Test) or just GTT is routinely undertaken between 24-28 weeks (typically 28 weeks). However there are recommendations for some more at risk individuals to be offered earlier testing. The National Institute for Health Care Excellence (NICE) recommends the following:
Woman who have had GDM in a previous pregnancy should be offered early self-monitoring of blood sugar (glucose) or a two-hour 75 g GTT as soon as possible after the first antenatal appointment. This is followed by a repeat GTT at 24-28 weeks of pregnancy if the first test is normal.
Women with other risk factors (see above) should have a GTT at 24-28 weeks.
The OGTT requires a period of fasting 10-12 hours, so it is best to have appointments for screening early in the morning to minimize inconvenience. The test involves taking a controlled amount of Glucose and having your blood taken before and at 1 hour and 2 hours post ingestion.
Your results will be the blood sugar levels of the three tests.
Typically the Fasting (first) should be below 5.1mmol, the second recording level should be below 10.ommol and the third below 8.5 mmol. Please feel free to discuss your results with Dr. Petrina.
The Risks of Diabetes in Pregnancy
There are various complications that may occur. Pre-conception care and good blood sugar (glucose) control before and during pregnancy can reduce these risks.
Problems during pregnancy
Problems for the baby after pregnancy
Problems for the mother
There are various complications that may occur. Pre-conception care and good blood sugar (glucose) control before and during pregnancy can reduce these risks.
Problems during pregnancy
- Premature birth: babies are more likely to be born early (before 37 weeks).
- There is an increased risk of miscarriage or of the baby dying late in the pregnancy (stillborn).
- Babies tend to be a higher birth weight and this may make giving birth much harder. There is an
- increased risk of your baby becoming distressed during labour (fetal distress).
- There may be too much fluid around your baby (polyhydramnios).
- You may experience more infections during the pregnancy and the infections may be severe.
- There is an increased risk of needing to give birth by caesarean section.
Problems for the baby after pregnancy
- Congenital abnormalities are more common.
- Low blood sugar (hypoglycaemia) is common and may be severe.
- Respiratory distress syndrome is more likely.
- Yellowing of your skin or the whites of your eyes (jaundice) is more common.
- Birth injury is more likely.
- There is an increased risk of the baby dying soon after birth.
Problems for the mother
- There is an increased risk of problems during the pregnancy, including high blood pressure and blood clots.
- There is an increased risk of the blood sugar being very high (ketoacidosis) or too low.
- There is also risk that long-term diabetes complications may become worse, including eye problems and kidney problems.
Treatment
GDM can cause serious consequences for you and your baby but these can be greatly reduced by treatment. Treatment includes following advice about diet and physical activity. Medicines to lower your blood sugar levels may be required. The medicines may be tablets (for example, metformin) but insulin injections may also be needed.
After your pregnancy
Insulin and other medicines to control your blood sugar are usually stopped immediately after delivery.
Most women with GDM recover after the pregnancy but there is an increased (2 in 3) risk of it returning in a future pregnancy. Women who have had GDM are at increased risk of developing diabetes in the future. It is recommended that women with GDM:
GDM can cause serious consequences for you and your baby but these can be greatly reduced by treatment. Treatment includes following advice about diet and physical activity. Medicines to lower your blood sugar levels may be required. The medicines may be tablets (for example, metformin) but insulin injections may also be needed.
After your pregnancy
Insulin and other medicines to control your blood sugar are usually stopped immediately after delivery.
Most women with GDM recover after the pregnancy but there is an increased (2 in 3) risk of it returning in a future pregnancy. Women who have had GDM are at increased risk of developing diabetes in the future. It is recommended that women with GDM:
- Avoid weight gain, and if necessary lose weight.
- Exercise and remain active
- Don't Smoke.
- Adhere to the minimum recommended time of 12-18 months post birth conception
- Try to avoid having pregnancies with only a short time (for example, a few months) between each pregnancy.
- Attend the six-week postpartum check and have a blood sugar test taken.
- Have your blood sugar level checked each year.
Further reading & references
- Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period; NICE Clinical Guideline (February 2015)
- Preconception care for women with diabetes; Diabetes UK, May 2015
