Gestational Diabetes

What is Gestational Diabetes
Why Does Gestational Diabetes Occur?
Why should we take Gestational Diabetes seriously
What are the long-term effects of Gestational Diabetes?
What are the symptoms of Gestational Diabetes?
What are the risk factors for Gestational Diabetes?
How is Gestational Diabetes screened for in pregnancy?
How is Gestational Diabetes managed during pregnancy?
If I have had Gestational Diabetes before, how can I plan for future pregnancies?
Life-Long Type 2 Diabetes Screening
Life-Long Type 2 Diabetes Screening
How can I find out information about the local Diabetes Maternity Service?

What is Gestational Diabetes?

Gestational diabetes is a type of diabetes that develops during pregnancy. It can happen at any stage of pregnancy, but typically occurs around the 24th to 28th week of pregnancy.

You can read more about this and whether you may be at risk on the NHS website: Gestational diabetes – NHS (www.nhs.uk)

What can I do?

• If you’re at risk for gestational diabetes during pregnancy, go to your antenatal appointments and take your glucose tolerance test. It’s important to identify and manage gestational diabetes for a healthy pregnancy.
• Talk to your midwife or doctor if you’re worried about any symptoms that might be related to diabetes.
• If you’ve had gestational diabetes before and are planning to get pregnant, get checked for diabetes before you conceive. Your GP can help with this.
• If you’ve had gestational diabetes before or have type 1 or type 2 diabetes, it’s a good idea to prepare for pregnancy. See your GP before stopping contraception to review your medications, make lifestyle and diet changes, lose weight if needed, stop smoking, and start taking folic acid. Attending a preconception clinic is helpful if you have type 1 or type 2 diabetes.
• After having gestational diabetes during pregnancy, get a blood test for Type 2 diabetes 6 to 13 weeks after giving birth, and then once a year.
• To prevent gestational diabetes in future pregnancies or the progression to Type 2 diabetes, adopt a healthy lifestyle. The FREE ‘Healthier You’ NHS Diabetes Prevention Programme can help reduce your risk of developing Type 2 diabetes by up to 37%.

Why Does Gestational Diabetes Occur?

During pregnancy, the placenta makes hormones that can make your body less responsive to insulin, which is the hormone that controls blood sugar levels. In gestational diabetes, your body can’t produce enough insulin to handle this resistance, causing your blood sugar levels to rise. This leads to gestational diabetes.

Why should we take Gestational Diabetes seriously?

Managing gestational diabetes with healthy living and exercise is important to minimise the chance of complications occurring for both you and your baby.

Gestational diabetes can cause problems such as:

• your baby growing larger than expected – this may lead to difficulties during the birth and increases the likelihood of needing induced labour or a caesarean section
• polyhydramnios – too much amniotic fluid (the fluid that surrounds the baby) in the womb, which can cause premature labour or complications at birth
• premature birth – giving birth before the 37th week of pregnancy
• pre-eclampsia – a condition that causes high blood pressure during pregnancy and can lead to pregnancy complications if not treated
• your baby developing low blood sugar or yellowing of the skin and eyes (jaundice) after they are born, which may require treatment in hospital
• the loss of your baby (stillbirth) – though this is rare
• Newborn Hypoglycaemia- Low blood sugar levels in your baby for the first 1-2 days after birth.

What are the long-term effects of Gestational Diabetes?

Gestational diabetes normally goes away after birth. But people who have had it are more likely to develop:

• Gestational Diabetes again in future pregnancies– up to 80% chance of recurrence in future pregnancies.
• Type 2 Diabetes – a lifelong and permanent type of diabetes that can seriously impact your heart, eyes, kidneys, feet and nerves.

Up to 50% of people who have gestational diabetes in pregnancy go on to develop Type 2 Diabetes within 5-10 years of giving birth in the UK. Whilst this is a worry, there are lifestyle changes that you can make to help to prevent you getting type 2 diabetes.

What are the symptoms of Gestational Diabetes?

Gestational diabetes does not usually cause any symptoms- most cases are discovered through a routine screening test for gestational diabetes during pregnancy.

Some people may develop symptoms if their blood sugar level gets too high (known as ‘hyperglycaemia’), such as:

• increased thirst
• needing to urinate more often than usual
• a dry mouth
• tiredness
• blurred eyesight
• genital itching or thrush

Please be aware: Some of these symptoms are common during pregnancy and are not necessarily a sign of gestational diabetes. Speak to your midwife or doctor if you’re worried about any symptoms you’re experiencing.

What are the risks of Gestational Diabetes?

Several factors can increase your chances of developing gestational diabetes during pregnancy. These include:

• Having had gestational diabetes before
• Having had a baby that weighed 4.5 kg or more before
• Having a higher body weight- a Body Mass Index (BMI) above 30 kg/m2
• Having a first degree relative with Type 1 or Type 2 diabetes (Biological parent or sibling)
• Having a family ethnic origin with a higher risk of developing diabetes

Understanding these risk factors can help you to decide to take steps to reduce your risk of gestational diabetes in future pregnancies.

During your first antenatal appointment (also called a booking appointment) at around week 8 to 10 weeks of your pregnancy, your midwife will ask you some questions to find out if you have an increased chance of developing gestational diabetes.

If you have 1 or more risk factors for gestational diabetes you should be offered a screening test.

How is Gestational Diabetes screened for in pregnancy?

The screening test is called an oral glucose tolerance test (OGTT) which is usually done between the 24th and 28th week of pregnancy. If you have had gestational diabetes before in a previous pregnancy, you will be offered the OGTT earlier in your pregnancy and again between 24-28 weeks of pregnancy if the first test result is normal.

An oral glucose tolerance test measures how your body processes sugar and is usually done in the hospital pregnancy outpatient department.

It involves having a ‘fasting’ blood test in the morning- when you have not had any food or drink for 8 to 10 hours prior (though you can drink plain water).

You are then given a specific sugary drink to drink.

After resting for 2 hours, another blood sample is taken to see how your body is processing the sugary drink.

The infographic on the Leeds Maternity Service Website provides more information on OGTT: https://www.leedsth.nhs.uk/patients/resources/glucose-tolerance-test-infographic/

https://www.leedsth.nhs.uk/patients/resources/glucose-tolerance-test/

How is Gestational Diabetes managed during pregnancy?

Healthy Eating: Follow a balanced diet plan tailored to your needs. Your healthcare provider can help you develop a meal plan that keeps your blood sugar levels stable2.

Regular Exercise: Physical activity helps control blood sugar levels. Consult your healthcare provider to determine the safest exercise routine for you2.

Blood Sugar Monitoring: Regularly check your blood sugar levels to ensure they remain within the target range2.

Medication: In some cases, insulin injections or other medications may be necessary to manage blood sugar levels2.

After Pregnancy Gestational diabetes usually resolves after delivery, but it’s important to mo

https://www.leedsth.nhs.uk/patients/resources/gestational-diabetes-care-pathway/

https://www.leedsth.nhs.uk/patients/resources/pregnancy-and-gestational-diabetes/

If I have had Gestational Diabetes before, how can I plan for future pregnancies??

If you’ve had gestational diabetes before and you are planning to get pregnant, make sure you get checked for diabetes, ideally before becoming pregnant- Your GP can arrange this.

If you do have diabetes, you should be referred to a diabetes pre-conception clinic for support to ensure your condition is well controlled and your health optimised before you get pregnant.

There is more information on the NHS Website about planning a pregnancy if you have type 1 or type 2 diabetes: https://www.nhs.uk/pregnancy/related-conditions/existing-health-conditions/diabetes/

In preparation for any future pregnancies – it is worth planning to be pregnancy ready. This means arranging to see your GP before stopping your contraception, so that they can review any medications you’re taking for suitability in pregnancy, support you to make further lifestyle and diet changes, including weight loss if needed, help you to stop smoking, and start you on Folic Acid.

These “pregnancy ready” changes will help you have a healthy pregnancy and healthy baby.

If you have had gestational diabetes before in a previous pregnancy, there is a higher chance it will occur again in future pregnancies- if pre-pregnancy tests show you do not have diabetes, your midwife will ensure you are offered an oral glucose tolerance test early in your next pregnancy (around 12 weeks of pregnancy) and again between 24-28 weeks of pregnancy if the first test result is normal.

Life-Long Type 2 Diabetes Screening

You should have a blood test to check for Type 2 diabetes 6 to 13 weeks after giving birth, and once every year after that, if the result is normal. During these appointments, you’ll also be advised about things you can do to reduce your risk of getting diabetes, such as maintaining a healthy weight, eating a balanced diet and exercising regularly.

See your GP if you develop symptoms of high blood sugar, such as increased thirst, needing to pass urine more often than usual, and a dry mouth – do not wait until your next test.

You should have the tests even if you feel well, as many people with diabetes do not have any symptoms.

Life-Long Type 2 Diabetes Prevention

‘Healthier You’: NHS National Diabetes Prevention Programme

Up to 50% of people diagnosed with gestational diabetes develop Type 2 diabetes within 5 years of the birth. Eating healthily and completing regular physical activity helps people to not only lose any excess weight gained during pregnancy but can also lower the risk of developing Type 2 diabetes. The Healthier You NHS Diabetes Prevention Programme is available to help you to improve your health and wellbeing and reduce your risk of developing type 2 diabetes if you have previously had a diagnosis of gestational diabetes.

It is a free programme that provides participants with 13 friendly and supportive group-based sessions over nine months with a trained health coach. The sessions can be attended face-to-face at a local venue, remotely or via a digital app.

You will be able to self-refer whilst pregnant to be ready to start the programme after your pregnancy.

For more information about the programme and how to sign-up, click the link here: https://healthieryou.reedwellbeing.com/gestational-diabetes/

Please note: If you have been diagnosed with Type 2 diabetes during or immediately after pregnancy you will not be eligible for this programme but there are other programmes and support that you can access.

Lifestyle Considerations

Preventing gestational diabetes in future pregnancies or the progression to developing Type 2 Diabetes following a diagnosis of gestational diabetes, involves adopting life-long healthy lifestyle adaptations. Here are some key things to consider:

1. Maintain a Healthy Weight

Before Pregnancy: If you’re planning to get pregnant, aim to reach a healthy weight before you conceive. Losing excess weight before conceiving can reduce your risk of developing diabetes and high blood pressure in pregnancy.

During Pregnancy: Weight loss is not encouraged but eating a healthy balanced diet and doing regular physical activity will help to limit excessive weight gain.

2. Eat a healthy, balanced Diet

Aim for a healthy balanced diet with plenty of fruit and vegetables, whole grains, fibre and lean sources of protein. Limit your sugar, saturated fat and salt consumption as these can increase your risk of health problems and type 2 diabetes if consumed in excess. For more information on eating healthily, click this link: https://www.nhs.uk/live-well/eat-well/how-to-eat-a-balanced-diet/eating-a-balanced-diet/

3. Stay Physically Active

Engaging in regular physical activity before and during pregnancy can help manage weight and improve fitness. Aim for 150 minutes of moderate-intensity physical activity per week which is just 30 minutes a day for 5 days (such as walking with the pushchair, parent and child physical activity classes or online workouts). Do muscle-strengthening physical activities on two days a week (such as house chores like gardening, carrying heavy bags and yoga). Break up long periods that you spend sitting and add physical activity into everyday habits and chores (such as marching on the spot while you wait for the kettle to boil).

More information on physical activity guidance for pregnancy, post birth and for general adults can be found here:

Pregnancy Guidance: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1054538/physical-activity-for-pregnant-women.pdf

https://www.activepregnancyfoundation.org/pregnant

Birth to 12 months guidance: https://assets.publishing.service.gov.uk/media/620a2ff9d3bf7f4f0ec9b574/postpartum_infographic.pdf

General Adult guidance: https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-for-adults-aged-19-to-64/

5. Address Unhealthy Lifestyle Habits and Addictions

Refrain from drinking alcohol and smoking: not drinking alcohol and not smoking can significantly reduce your risk of developing type 2 diabetes and improve your longer term health. Also, providing a smoke-free household for your baby and family will benefit their health and wellbeing.

6. Take care of your mental health and wellbeing:

This includes following good sleep hygiene, practising stress management techniques, self-care and developing healthy habits.

Family health considerations:

Some research has suggested that babies of mothers who had gestational diabetes may be more likely to develop diabetes or become obese later in life. Adopting a whole family approach to healthy living can help reduce the chances of this.

“HENRY” is  valuable resource to access and supports whole families in Leeds to make healthy choices and positive lifestyle changes: https://www.henry.org.uk/parents

How you choose to feed your baby is a personal choice and more information can be found about the different methods of feeding here: https://www.nhs.uk/start-for-life/baby/feeding-your-baby/  However, it is worth noting that Breastfeeding offers numerous benefits specific to people who have had gestational diabetes or are at risk of developing type 2 diabetes, including:

Health Benefits for the Baby:

Lower Risk of Diabetes: Breastfed babies have a reduced risk of developing diabetes and becoming overweight or obese later in life.

Immune System: Breastfeeding helps protect babies from allergic conditions, infections, asthma, and respiratory diseases.

Stable Blood Sugar Levels: For babies born with low blood sugar (hypoglycaemia), breastfeeding can help stabilize their blood sugar levels after birth.

Longer-Term Benefits

Reduced Obesity Risk: Breastfeeding can lower the risk of obesity in childhood and adolescence.

Lower Risk of Chronic Diseases: It may also reduce the risk of developing hypertension, cardiovascular disease, and other chronic conditions later in life.

How can I find out information about the local Diabetes Maternity Service?

The below page links to information about the Diabetes Maternity Service at Leeds Teaching Hospitals NHS Trust:

Diabetes specialist midwives – Leeds Teaching Hospitals NHS Trust (leedsth.nhs.uk)

Here you can find links to patient information leaflets on:

• Pre-pregnancy advice for women with pre-existing diabetes: Pre‑Pregnancy Advice For Women With Diabetes – Leeds Teaching Hospitals NHS Trust (leedsth.nhs.uk)
• Pregnancy and Type 1 Diabetes: Pregnancy and type 1 diabetes – Leeds Teaching Hospitals NHS Trust (leedsth.nhs.uk)
• Pregnancy and Type 2 Diabetes: Pregnancy and type 2 diabetes – Leeds Teaching Hospitals NHS Trust (leedsth.nhs.uk)

The Leeds Diabetes Midwives can be contacted directly on the following team email:

[email protected]