Diabetes in Pregnancy – will this affect me?

What is Gestational Diabetes?

Between 5 and 10% of women develop diabetes in pregnancy (NICE). This is known as gestational diabetes,or GDM for short.

It happens because during pregnancy, our body becomes less good at handling the sugar we eat. Every time you eat sugar or carbohydrate, your body produces Insulin which controls being able to move than insulin into the cells. During pregnancy, we naturally become more resistant to the insulin that our own bodies produce and this leads to diabetes developing. In diabetes, the body has raised blood sugar levels because the insulin can’t move the sugar from the blood into the cells efficiently enough or at all.

What are the risks of diabetes in pregnancy?

This is important in pregnancy, because the higher levels of sugar pass very easily across the placenta to the baby. This usually means that the baby grows more than expected and becomes bigger than it would be otherwise. This extra weight, a bit like after birth, gets laid down as fat. Those who are having bigger babies experience more complications during labour, including emergency caesareans sections, and forceps deliveries for example.

One of the biggest concerns is the risk that the baby’s head delivers but then the shoulders get stuck, which is something called a shoulder dystocia (NICE). Whilst this is quite rare, it can be very serious. Mothers having big babies are also more likely to bleed heavily and have complicated perineal tears. 

There are also increased risks in the antenatal period if you have gestational diabetes. This includes an increased risk of pre-eclampsia and also an increased risk of stillbirth.

Are some people more likely to develop diabetes than others?

There are specific groups of women who are at increased risk of diabetes in pregnancy – for example, if you have a raised BMI, have a family history or come from particular ethnic groups, or if you have had GDM before. If this is the case you will be offered a test to screen for GDM at either 16 weeks (if you have had GDM before) or 26-28 weeks.  This test is called a glucose tolerance test (GTT). I have explained this test in another blog.

Is there anything I can do to reduce my risk of developing gestational diabetes?

If you are at increased risk of GDM, you may be able to reduce the chances of it developing by being very careful with diet and exercise. For example, avoiding consumption of high sugar foods and drinks, eating whole foods and grains, avoiding white bread, rice or pasta (eat wholewheat instead) and avoiding take aways and fast food.

Walking after a meal can also help your body metabolise the sugar and carbohydrate you eat.

What will happen if I get diagnosed with gestational diabetes?

If you are diagnosed with GDM then you will first be asked to monitor your blood sugars before and after a meal by using a finger prick test. This will determine what treatment is needed. Usually, diet and exercise are offered first and for many women this will be enough.

Some will need tablets, such as metformin as well to help control the blood sugar. A small number of women need treatment with insulin injections. You will also need growth scans to keep a regular check on the size of the baby. The doctor or midwife will explain these to you.

Often, those with GDM need to be delivered early, and this is determined by your blood sugar control and the size of the baby, or if you develop any complications. If your GDM is well controlled with diet only and the baby is a normal size then early delivery is much less likely to be needed and you may be able to wait until your labour starts by itself.

Will I have diabetes forever?

GDM always gets better when the baby is born. You will be asked to do some blood sugars after birth but most women are able to stop any treatment they have needed during pregnancy immediately.

However, one of the most important things to be aware of is that if you develop GDM in pregnancy you have a 50:50 chance of developing type 2 diabetes in the 5 years after the baby was born. This means that it is really important to attend the 6 week GTT check, and annual checks thereafter to screen for the development of type 2 diabetes.

Pregnancy acts a bit like a crystal ball to your future health. You can reduce the risks of developing diabetes by maintaining a healthy diet, regular exercise and keeping your weight in a healthy range.