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Diabetes in Pregnancy

This factsheet is for women who have diabetes that develops in pregnancy (gestational diabetes), or who would like information about it. It doesn't give advice for women who already have diabetes and would like to become pregnant.

Diabetes can develop during pregnancy in women who haven't previously had the condition. This is called gestational diabetes, and it affects around two to seven out of 100 pregnant women. It can lead to problems for the mother and baby if it isn't properly controlled.

Diabetes is a condition in which your blood sugar (glucose) level is high because there isn't enough insulin in your blood, or your body isn't responding to insulin properly. Insulin is a hormone that allows your body to break down sugar in your blood to be used as energy.

During pregnancy, various hormones block the usual action of insulin. This helps to make sure your growing baby gets enough sugar. Your body needs to produce more insulin to cope with these changes. Gestational diabetes develops when your body can't meet the extra insulin demands of the pregnancy.

Gestational diabetes usually begins in the second half of pregnancy, and goes away after your baby is born. If gestational diabetes doesn't go away after your baby is born, it's possible that you already had a slowly developing form of what is known as type 1 diabetes, and that it was picked up by chance during your pregnancy. The other form of diabetes is called type 2 diabetes and both type 1 and 2 are lifelong conditions. 

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.  

Gestational diabetes doesn't usually cause any symptoms. Sometimes you may have symptoms of high blood sugar, including:

  • increased thirst
  • needing to urinate often
  • feeling tired

However, these are also common symptoms of a normal pregnancy. 

Gestational diabetes isn't an immediate threat to your health. However, poorly controlled diabetes in pregnancy puts you at a higher risk of various problems. These include:

  • a condition called pre-eclampsia, which causes high blood pressure
  • premature labour
  • having too much amniotic fluid (the fluid around your unborn baby)

If you have gestational diabetes, you're more likely to need a caesarean delivery than women who don't have diabetes.

You're also more likely to develop gestational diabetes in future pregnancies, and are at a higher risk of developing type 2 diabetes later in life. 

If you have high blood sugar levels, your baby may grow to be larger than usual. This is because he or she has to make extra insulin to control the increased blood sugar, which causes more fat and tissue to be stored. This can make delivery difficult.

For example, there is an increased risk of shoulder dystocia. This is when your baby's head has been born but one of his or her shoulders is stuck behind your pelvic bone, preventing his or her body being delivered. This in turn can damage nerves in your baby's neck or result in a fracture of one of his or her arms or shoulders. Very rarely, it can cause brain damage if the blood supply to your baby's brain is blocked off for too long.
Your baby may have low blood sugar (hypoglycaemia) after birth. This is because he or she makes extra insulin to respond to your high blood sugar levels. Shortly after birth, your baby may continue to make extra insulin causing his or her blood sugar level to be too low.
It's recommended that you breastfeed your baby within 30 minutes of delivery to keep his or her blood sugar levels at a safe level. Otherwise, your baby may be given a sugar solution through a drip (directly into a vein). Midwives or doctors will check your baby's blood sugar level regularly.

Your newborn baby is at risk of jaundice (yellowing of the skin and whites of the eyes). This usually fades without the need for medical treatment. However, sometimes your baby may need treatment with a special ultraviolet light after being born.

There is a higher likelihood that your baby will be born with a birth defect. Sometimes, babies can be born with respiratory distress syndrome, in which the baby has problems breathing because his or her lungs haven't developed as they should. This usually clears up with time, although it may mean that your baby needs to be ventilated with a machine.

There is also a slightly higher chance of stillbirth or death as a newborn, but this is rare as long as blood sugar levels in both you and your baby are well controlled.

There is an increased risk of your baby becoming obese as a child and an increased risk of him or her developing diabetes during childhood. 

It's not yet known why some women develop gestational diabetes and others don't, but you're more at risk if you:

  • have a family history of gestational diabetes (ie your mother, grandmother or sister had it)
  • have previously given birth to a large baby, weighing over 4.5kg (9lb) are overweight or obese
  • have polycystic ovary syndrome (PCOS)

Women whose families originate from certain areas are also at a higher risk. These include women from South Asia (specifically India, Pakistan or Bangladesh), the Middle East (specifically Saudi Arabia, United Arab Emirates, Iraq, Jordan, Syria, Oman, Qatar, Kuwait, Lebanon or Egypt) and black Caribbean women

Gestational diabetes can be diagnosed using a glucose tolerance test, which is carried out in the morning, after you have eaten nothing overnight. Your doctor will give you a solution of glucose to drink and take blood samples at different intervals to see how your body deals with the glucose over time.

If you're at risk of developing diabetes in pregnancy, you will be offered a glucose tolerance test by your doctor or midwife between 24 and 28 weeks. If you have had gestational diabetes before, you will be offered a test at 18 weeks, and another one at between 24 and 28 weeks if the first is normal. 

Your GP will refer you to a clinic where the doctors and nurses are experienced in looking after pregnant women with diabetes. You will need to have more frequent antenatal appointments than women who don't have gestational diabetes.

Self-help

It's important that you control your blood sugar level. Most women can control it through a carefully planned diet and regular exercise.

Your doctor or a dietitian will be able to give you advice on what to eat. An important part of your diet will be to eat plenty of slowly absorbed carbohydrates such as wholemeal bread and pasta, oats, brown rice, potatoes, lentils and beans. These types of food have a low glycaemic index (GI) and can help even out blood sugar levels when you have diabetes.

Your meal plan will probably consist of these slow absorbing carbohydrates and a variety of lean proteins such as oily fishy, as well as at least five portions of fruit and vegetables each day. You can still eat the odd chocolate bar or packet of crisps but you need to make sure it's all part of a healthy, balanced diet low in fat, sugar and salt.

Regular moderate intensity exercise, such as walking or cycling, helps to reduce blood sugar levels and promote a sense of wellbeing. At least 30 minutes of activity that gets you slightly breathless each day is recommended by the Department of Health.

You will need to regularly test your blood sugar levels. Your doctor at the specialist clinic will give you advice on how to test your blood sugar level, how often to do it, and the levels that you're aiming for. You will probably need to do a test every day.

Medicines

Around one to two women out of 10 won't be able to control their gestational diabetes with diet and exercise and will need insulin injections or tablets. Your doctor or a specialist nurse will teach you how to do this.

It's possible to have too much insulin and this can cause low blood sugar (hypoglycaemia - sometimes called a 'hypo'). Common symptoms of this are paleness, shaking, hunger and sweating. Your doctor or specialist nurse will explain how to recognise the symptoms of hypoglycaemia, and what to do if it happens. For example, keeping a sugary soft drink handy is a good idea.

Occasionally, low blood sugar can cause you to lose consciousness, and you will need an injection if this happens.

It's a good idea for your family and friends to know what to do if your blood sugar gets very low and you pass out.

After your baby is born

You and your baby will have your blood sugar levels monitored after he or she has been born to make sure they are back to normal.

Doctors recommend that it's best to breastfeed your baby within 30 minutes of delivery to keep your baby's blood sugar levels at a safe level and then every two to three hours.

If you were taking any medication for diabetes, you can stop these after your baby is born. You will be given a blood sugar test at your six-week check-up. 

Healthy lifestyle choices reduce the risk of you getting type 2 diabetes if you have had gestational diabetes. Aim to eat a balanced diet, take regular exercise and maintain the correct weight for your height. 

1. How could gestational diabetes affect me during my pregnancy?

Being pregnant increases your chances of developing certain health problems. If you have gestational diabetes as well, the risk of some of these conditions is even greater.

Health problems linked to gestational diabetes include the following.

  • Early miscarriage. Diabetes that isn't well controlled can increase your chances of having a miscarriage in the first three months of pregnancy.
  • Pyelonephritis - an infection of your kidneys. Symptoms include a fever, feeling or being sick, pain in your middle and upper back, going to the toilet to pass urine often and finding it painful when you do. You will need to be treated in hospital with antibiotics.
  • Pre-eclampsia. This is a potentially very serious condition that causes high blood pressure and can damage your liver, kidneys, brain and the placenta. The main signs are high blood pressure and protein in your urine. It's important to attend all your antenatal appointments to have your urine and blood pressure checked so doctors can pick up any signs of pre-eclampsia early.
  • Too much amniotic fluid. Amniotic fluid is the fluid around your baby and having too much can lead to early labour and problems for you and your baby. Your doctor and midwife may either monitor you closely or admit you to hospital for treatment, depending on how severe the problem is.
  • Low (hypoglycaemia) and high (hyperglycaemia) blood sugar levels. Both high and low blood sugar levels can be very serious for you and your baby. It's important that you check your blood sugar levels regularly and that you and your friends and family know what to do if you become unwell.

Your midwife or doctor can give you advice and information about how to recognise the signs of low and high blood sugar levels and how to treat them.

If you feel unwell at all during your pregnancy, ask your doctor or midwife for advice.

2. Will gestational diabetes affect how my baby is born?

If your diabetes is well controlled and you don't have any other major health problems, a normal birth is possible. However, you're likely to be offered a planned birth either with induced labour or a caesarean section when your pregnancy has reached 38 weeks.

Having diabetes means that your baby may be larger and you may be more likely to have a slow or very painful labour. These are the reasons why you're more likely to need to have a caesarean section than other women who don't have diabetes. Your midwife and doctor will monitor your pregnancy closely and will discuss your options with you. If your baby is large your doctor is likely to recommend that he or she is delivered at 38 weeks.

During the final part of your pregnancy, your doctor and midwife will talk to you about pain control during your labour. Epidurals can be used safely in women who have diabetes. An epidural completely blocks feeling from the waist down and you will stay awake during the delivery. Once you're in labour your doctor and midwife will aim to keep your blood sugar levels between 4 and 7mmol/l.This might mean having insulin and glucose through a drip to help keep the levels well controlled.

You and your baby will be closely monitored all of the time that you're in labour to make sure that everything is happening safely. You will have your baby in a hospital that has the facilities to care for you both, should there be any problems or if you need treatment quickly. There should also be a doctor who specialises in caring for newborn babies present at the birth.

3. How long will it take for the diabetes to go away once the baby is born?

Usually diabetes that develops during your pregnancy (gestational diabetes) goes away within a few weeks of the birth of your baby. However, for some women their blood sugar levels don't return to normal and they are diagnosed with diabetes that needs life-long treatment.

You should be able to stop treatment for diabetes, including any insulin injections, after your baby is born. However, your nurse or doctor may give you information about a healthy lifestyle and ask you to make changes, such as being more active or losing weight. Leading a healthy lifestyle can help you to reduce your risk of developing diabetes in the future.

 

You will be asked to have your blood sugar level tested six weeks after the birth of your baby, to make sure that it has gone back to its pre-pregnancy levels. If the results of this test are normal, you will be asked to have regular checks in the future to monitor your blood sugar levels. This is because, having had gestational diabetes, you're more at risk of developing diabetes in the future than other women. This includes type 1 or type 2 diabetes and diabetes in pregnancy if you have another baby. You can reduce the likelihood of this by eating the right foods, being active and maintaining the right weight for your height.

If your test result shows that you still have raised blood sugar levels, you will be asked to have further tests to see whether you have type 1 or type 2 diabetes. If tests confirm this, your doctor will discuss your treatment options with you.

Further Information

Sources

  • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010: 826
  • Management of diabetes. Scottish Intercollegiate Guidelines Network (SIGN), March 2010. www.sign.ac.uk
  • Diabetes in pregnancy. National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk
  • Chamberlain G, Steer P. Turnbull's obstetrics. 3rd ed. London: Churchill Livingstone, 2001:275–80
  • Reece E, Leguizamón G, Wiznitzer A. Gestational diabetes: the need for a common ground. The Lancet 2009; 373(9677):1789–97. doi:10.1016/S0140-6736(09)60515-8
  • Gestational diabetes. Diabetes UK. www.diabetes.org.uk, accessed 10 October 2011
  • Diabetes – type 2 – management. Prodigy. www.prodigy.clarity.co.uk, published July 2010
  • Greer I. Pregnancy: the inside guide. 1st ed. London: Collins, 2003
  • Kim C. Gestational diabetes: risks, management, and treatment options. Int J Womens Health, 2010; 2:339–51. doi:10.2147/IJWH.S13333
  • Shoulder dystocia. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published December 2005
  • Respiratory distress syndrome. eMedicine. www.emedicine.medscape.com, published 10 October 2011
  • Blood glucose targets. Diabetes UK. www.diabetes.org.uk, published January 2009
  • Dietary interventions and physical activity interventions for weight management before, during and after pregnancy. National Institute for Health and Clinical Excellence (NICE), 2010. www.nice.org.uk
  • Start active, stay active: a report on physical activity from the four home countries’ Chief Medical Officers. Department of Health, 2011. www.dh.gov.uk
  • Your food choicesdiabetes. The British Dietetic Association. www.bda.uk.com ,published November 2007
  • Joint Formulary Committee. British National Formulary. 62nd ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2011
  • Hypoglycaemia. Diabetes UK. www.diabetes.org.uk, published December 2009
  • Insulin therapy in type 2 diabetes – management. Prodigy. www.prodigy.clarity.co.uk, published November 2010
  • Pre-eclampsia: what you need to know. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published 1 November 2007
  • Hypers. Diabetes UK. www.diabetes.org.uk, accessed 10 October 2011
  • Pediatric polyhydramnios and oligohydramnios. eMedicine. www.emedicine.medscape.com, published 14 February 2008

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