Diabetes--------
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Gestational
Diabetes
What
is gestational diabetes?
Gestational diabetes is a condition that develops during
pregnancy. The mother has an abnormally large amount of
sugar in her blood. It usually resolves itself after the
baby is born - unlike other types of diabetes which are
lifelong conditions.
Diabetes develops when the body can't produce enough insulin,
a hormone made by the pancreas. Insulin regulates the
amount of sugar available in the blood for energy, and
enables any sugar that isn't immediately required to be
stored.
Your body has to produce extra insulin to meet your baby's
needs - especially from mid-pregnancy onwards. If your
body can't manage this, you may develop gestational diabetes.
Your blood sugar levels may also rise because the hormonal
changes of pregnancy interfere with insulin function.
If you are found to have sugar in your urine when you
attend the antenatal clinic, your GP or midwife will probably
suggest that you have what is called a random blood glucose
test to get a more accurate estimate of the amount of
sugar in your blood. If the result is high, you will be
referred for a glucose tolerance test. You may be asked
to attend a special diabetic clinic to have this test
done.
How
will having diabetes affect my pregnancy?
This really depends on how well you look after yourself.
If you can control your diabetes carefully, you will be
doing the best that you can for your baby.
The main problem with having too much sugar in your blood
is that it crosses the placenta to your baby, which means
that he can grow very large. A big baby may make labour
and delivery more difficult and your chances of needing
a caesarean section are increased. There is more likelihood
of your baby being jaundiced or having breathing problems
if he has to be born surgically.
Some researchers believe large babies are more prone to
obesity later in life. As adults, they are also more likely
to develop diabetes.
Babies born to women who were diabetic before they became
pregnant have a greater risk of health problems - especially
if the pre-pregnancy diabetes was poorly controlled.
Who is at
risk of developing gestational diabetes?
Women who have had gestational diabetes in a previous
pregnancy, or who have previously given birth to one or
more large babies are at risk of gestational diabetes.
Other women who are at greater risk of developing the
condition include:
• Obese women (BMI greater than 30)
• Older mothers (everyone's tendency to develop diabetes
increases with age)
• Women with a parent or sibling who is an insulin-dependent
diabetic
• Women who are Asian-Indian, African-Caribbean or
from the Middle East.
Will
I know if I have gestational diabetes?
You probably won't know unless the problem is picked up
at your antenatal clinic. A few women experience extreme
thirst or abnormal fatigue which are signs of diabetes.
How
is gestational diabetes treated?
Your midwife or the specialist you see at the diabetic
clinic will give you advice on how to control your blood
sugar level by cutting down on sugary foods and drinks
that contain caffeine such as coffee and cola. You will
be helped to look at your eating patterns, and advised
to eat frequent small snacks rather than a few large meals
which put a strain on your body.
A few women with very severe gestational diabetes that
can't be controlled by diet and exercise may be prescribed
insulin injections. You will be taught how to give these
to yourself. Whether you need insulin injections or have
a milder form of gestational diabetes, your baby will
be monitored closely and you will probably be advised
to have frequent ultrasound scans to check on how he is
growing. Some experts feel that this kind of surveillance
is unnecessary and there is no doubt that it tends to
make some women feel anxious rather than reassured.
I've
heard that exercise can help. Is that true?
Yes. Getting enough exercise is important, and your midwife
will discuss with you how you can include exercise in
your everyday life. Get some ideas for exercises that
might suit you from our fitness during pregnancy area.
Research shows that exercise helps keep blood sugar levels
in check and other evidence suggests that exercising before
you get pregnant helps prevent gestational diabetes.
What
can I do if I am already diabetic?
If you have diabetes and are planning to become pregnant,
try to make sure that your blood sugar levels are well
under control before you conceive. High blood sugar in
the first three months of pregnancy increases the risk
of your baby not developing properly. Your pregnancy will
probably be considered high-risk, but that doesn't necessarily
mean that you will have problems, especially if you continue
to keep your blood sugar levels as close to normal as
possible.
Will
I continue to have diabetes after my baby is born?
You will be offered a glucose tolerance test approximately
three months after your baby is born and it is very probable
that your blood sugar levels will have returned to normal.
Nonetheless, if you have had gestational diabetes, it
is more likely that you will develop diabetes later in
life. Women who were obese before and during pregnancy
often remain diabetic after pregnancy.
Ante-natal
Care
· Ante-natal care should be hospital-based, from
a multi-disciplinary team
· Individualise insulin regimens and recommend
4-times daily glucose monitoring.
· Aim to maintain glucose 4-7 mmol/L and HbA1c
within the normal non-diabetic range
· Remember insulin requirements increase progressively
from the 2nd trimester until the last month of gestation,
when a slight fall-off may be noted
· Hypoglycaemia and loss of awareness is common
in early pregnancy. Hypoglycaemia does not appear to
have long-term adverse effects on fetal development
· Ketoacidosis can cause fetal death at any stage.
All women should test urine for ketones if blood glucose
is high, if vomiting occurs or if they are unwell.
Delivery
· The timing of delivery is individualised; in
women with good diabetes control and no complications,
the pregnancy may be continued to 39-40 weeks
· Caesarian section rates are often higher than
in non-diabetic women.
Post-natal Care
· Insulin requirements fall dramatically after
delivery, therefore reduce insulin doses immediately
to pre-pregnancy levels, to avoid hypoglycaemia
· Encourage slightly higher blood glucose levels
than during pregnancy
· In breast-feeding mothers, reduce insulin dose
further once lactation is established
· Discuss contraception while the patient is
still in hospital
All women should be seen by the diabetes pregnancy care
team six weeks after delivery
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