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Gestational Diabetes

Gestational Diabetes is a form of diabetes that can develop during pregnancy. It is easily managed, but can have consequences for the mother and developing baby if it's left untreated. Fortunately, gestational diabetes often disappears after giving birth, but for some women diabetes will stay with them.

With early detection and the right treatment gestational diabetes can be managed with diet and lifestyle changes but on occasion medication is needed to help control blood sugar levels.

What is Gestational Diabetes?

Gestational diabetes is a form of diabetes different from the autoimmune-based type 1 diabetes and type 2 diabetes, which is usually the result of a poor diet and weight management.

Gestational diabetes occurs when a pregnant woman's body cannot make enough insulin to control her blood sugar levels. This is because pregnancy changes a woman's hormones and insulin needs.

Symptoms of Gestational Diabetes
Passing urine more often Increased thirst Dry mouth Frequent bladder infections (less common)
Extreme tiredness Nausea Joint pain Blurred vision (less common)

Insulin is the hormone that controls blood sugar. It's made by cells in the pancreas that turn blood sugar into the glucose that we use as fuel. If you don't have enough insulin to convert blood sugar then levels rise and cause complications.

Gestational diabetes is more likely to occur in the second half of a pregnancy, but it can develop at any point after conception. All women are at risk of gestational diabetes but the risk is higher if:

  • You are overweight
  • You've had it before
  • You've previously had a baby over ten pounds in weight
  • Your mother or sibling had it
  • Or you're of South Asian, Chinese, African-Caribbean or Middle Eastern descent.

One of the difficulties in diagnosing gestational diabetes is that symptoms are very similar to pregnancy symptoms experienced by most women, and this means it may remain undetected. Most cases of gestational diabetes are discovered by a midwife during routine screening.

Why is Gestational Diabetes a problem?

Women with gestational diabetes ask whether it affects their baby. The answer is yes, if it's left unmanaged diabetes can have serious consequences for the mother, her unborn baby and a newborn.

Complications that affect a growing foetus include:
Polyhydramnios A condition called polyhydramnios, which means there is too much amniotic fluid. It can cause premature labour and delivery issues.
Large baby The baby may grow larger than normal as a result of extra sugar. This means labour becomes riskier. Larger babies may need delivery through caesarean section, or you may need to be induced before full term. It's important to stay in touch with your midwife or doctor if you have gestational diabetes so they can measure your baby's growth and decide with you the safest method of birth.
Stillbirth A stillbirth means the baby dies during delivery. Stillbirth is rare, but it is still a risk associated with unmanaged gestational diabetes.
A newborn baby faces other risks too:
Low Blood Sugar A newborn may develop low blood sugar after birth. If this isn't treated it can lead to brain injury or developmental difficulties.
Higher Risk of Jaundice Gestational diabetes creates a higher risk of jaundice in newborns, which may need treatment and a hospital stay.
Higher Risk of Obesity The baby faces a higher risk of being obese or developing type 2 diabetes as they grow up.
Dangers of gestational diabetes to expectant and new mums include:
Pre-Eclampsia Gestational diabetes can lead to pre-eclampsia. This is high blood pressure that can lead to a number of dangerous pregnancy complications.
Higher Risk of Type 2 Diabetes Mothers who have experienced gestational diabetes remain at higher risk of developing type 2 diabetes, which is a lifelong condition requiring daily management.

Whilst gestational diabetes is easily managed, it can lead to serious consequences if it is not treated promptly. Managing blood sugar levels during pregnancy is important for mother and baby's health in both the short and long term.

Often gestational diabetes can be treated through diet, exercise and lifestyle changes but some women will need to inject insulin or take other medications to manage their blood sugar levels.

Testing for Gestational Diabetes

Because the symptoms of gestational diabetes are so similar to those experienced during pregnancy it can remain undetected until you have your antenatal appointments at around 8 weeks or 24 weeks.

Diabetes Glucose Tests; Blood glucoses test types for diabetes assessment

At your first antenatal appointment your midwife or doctor will ask questions to assess your risk and look for symptoms of diabetes. If you are thought at risk of having or developing gestational diabetes you'll undertaken a screening to make sure. Gestational diabetes is usually diagnosed through a blood test at 24–28 weeks into pregnancy.

  • The screening process, known as the oral glucose tolerance test, takes around two hours.
  • You need to have a blood test in the morning after a night's fast and then take a glucose drink with your midwife.
  • After two hours have passed your blood is re-tested and this second blood test indicates how well you have dealt with the rise in blood sugar.

Treating Gestational Diabetes

If you're diagnosed with gestational diabetes it will need immediate management. Some women are given a week to two weeks to manage blood sugar through diet, but if you are unable to lower glucose levels through food alone, medication may be needed.

There are limited options for gestational diabetes as some of the more common treatments are not suitable for pregnant women, but you may be prescribed Metformin, an oral tablet that boosts how well insulin works, or inject insulin as an alternative.

Monitoring your blood glucose levels is part of learning how to manage the condition. Pregnant women with diabetes should use a blood glucose monitor so they can regularly check levels and take action to manage them. Monitors are available from your diabetes team or your midwife.

You'll have more frequent ultrasounds, tests and screenings than women without gestational diabetes, so the health and the size of your baby are properly monitored for a healthy birth.

What can pregnant women with Gestational Diabetes eat?

If you're at risk of or have gestational diabetes one of the first ways you need to tackle it is through your diet.

Your doctor or midwife will have plenty of experience with diet and gestational diabetes so ask all the questions you need. It's important you have a good understanding of gestational diabetes effects on your body, so you can avoid or counteract sugar level rises.

Managing a diet in pregnancy can feel difficult because it's a time when you crave certain foods and feel nauseous when faced with particularly strong smells such as spices or fish, but there are enough suitable healthy foods to eat so you can work around any preferences you may develop.

There's no special 'diabetes' diet for any type 1, type 2 or gestational diabetes. Instead a dietician will recommended a sensible eating plan that manages the amount of blood sugar in your system. Eating food high in sugars and carbohydrates means your blood sugar levels raise quickly and without insulin you'll become hyperglycaemic.

Eating to manage diabetes doesn't mean you have to avoid all tasty foods and the things you enjoy, but changes are important and healthy foods can make a real difference to you and your baby's health.

All pregnant women should avoid certain foods

Ensure you follow the NHS guidelines on which foods to avoid in pregnancy. These include the following:

Foods to AVOID during Pregnancy
Certain Cheeses Fish with high mercury levels* Uncooked Eggs
Uncooked Meat Liver Unpasteurised Dairy

*Such as swordfish, shark and merlin, and too much tinned tuna.

Even if you have gestational diabetes this still leaves you with a wide range of foods to choose from, which can be managed to control your blood sugar levels.

Managing Carbohydrates

Carbohydrates impact blood sugar levels so it's important to monitor your intake and cut down if you eat a lot of carbs.

Try switching from white refined versions of bread, pasta and rice to wholemeal brown versions and eat fewer white potatoes.

How to snack with Gestational Diabetes

All pregnant women snack to avoid morning sickness and because they often feel hungrier, there is nothing wrong with snacking so long as you make good choices of vegetable sticks, fruit, yoghurt, nuts, seeds or avocado – but not too much in one portion.

All pregnant ladies should avoid eating too much junk food, but if you have gestational diabetes it's even more important to avoid crisps, chocolate, cakes and fizzy or energy drinks as these are full of sugar with no nutritional value, and will cause a rapid rise in blood sugar levels.

The perils of unrefined sugar

Sugar is called different names depending on its source or purpose. Read food labels to identify sugar in all its forms– sucrose, glucose, dextrose, fructose, lactose, maltose, honey, invert sugar, syrup, corn sweetener and molasses are all forms of sugar.

Sugar is also present in fruit juices and smoothies. It's better to eat pieces of fruit than drink juice because juices break down very quickly. Drink no more than 150mls of fruit juice a day to manage blood sugar levels and avoid drinks with added sugar.

Healthy Food for Gestational Diabetes

The healthy foods on this list can be eaten by women experiencing gestational diabetes as part of a varied and sensible diet.

  • Vegetables fresh or frozen
  • Fruit
  • Eggs
  • Porridge with berries
  • Chicken, oily fish, turkey
  • Air popped popcorn
  • Sugar free Greek yoghurt
  • Beans
  • Chickpeas

When should women with gestational diabetes eat?

Eating at regular intervals is a good way to maintain steady blood sugar in gestational diabetes.

Bingeing on a large amount of foods in one sitting will spike your blood sugar and make it difficult for reduced insulin levels to manage the rise. It's better to eat small amounts regularly throughout the day rather than one big meal in the evening.

You might think that skipping meals will lower blood sugar, but that's not the case. Missing meal times, particularly breakfast, leads to unstable blood sugar. Your aim is a steady low amount of glucose, which is best managed through three meals a day and two snacks in between rather than avoiding food for a long period of time.

Will I have Gestational Diabetes forever?

Gestational diabetes often disappears after birth as hormones return to pre-pregnancy levels and insulin begins to flow normally again.

You will have blood sugar tests after giving birth to ensure you are within a safe limit. If you can, breastfeeding soon after birth can help lower blood sugar. After six weeks you'll have another check up on blood glucose.

It's important to learn how to manage gestational diabetes because it puts you at a higher risk of developing type 2 diabetes. It's estimated that half of women with gestational diabetes develop type 2 within 10 years. Continue with the dietary changes you've made to limit your risks.

Some women find their blood glucose levels do not return to normal after they given birth and that means developing type 2 is more likely.

It is also possible that diabetes experienced during pregnancy is previously undiagnosed type 2 diabetes. If this is the case, you will continue to have diabetes after giving birth.

Gestational Diabetes is one of the most common conditions in pregnant women and when diagnosed it's simple to manage, often regulated through diet and exercise without the need for medications.

However, in some cases expectant mums will need to take medication in the form of insulin or metformin to keep glucose at a safe level throughout their pregnancy.

Last Updated: 04.04.2018

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