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Gestational diabetes is a type of diabetes that affects women during pregnancy.

Diabetes
is a condition where there is too much glucose (sugar) in the blood.
Normally, the amount of glucose in the blood is controlled by a hormone called insulin.
However, during pregnancy, some women have higher than normal levels of glucose in their
blood and their body cannot produce enough insulin to transport it all into the cells. This
means that the level of glucose in the blood rises.

Types of diabetes
Gestational diabetes is diabetes first diagnosed during pregnancy. The two other main types
of diabetes are:

type 1 diabetes when the body produces no insulin at all (often referred to as
juvenile diabetes or early-onset diabetes)
type 2 diabetes when the body doesn't produce enough insulin and/or the bodys
cells do not react to insulin (insulin resistance)

See the relevant links above for women who already had diabetes before they became
pregnant.

How common is gestational diabetes?


Two to five in every 100 women giving birth in England and Wales has diabetes. Most of
these women have gestational diabetes, and some have type 1 or type 2 diabetes.
Outlook
Gestational diabetes can be controlled with diet and exercise. However, some women with
gestational diabetes will need medication to control blood glucose levels. Read more
about how gestational diabetes is treated.
If gestational diabetes is not detected and controlled, it can increase the risk of birth
complications, such as babies being large for their gestational age (Macrosomia). Read about
the complications of gestational diabetes for more information about the risks of this and
related conditions.
In most cases, gestational diabetes develops in the third trimester (after 28 weeks) and usually
disappears after the baby is born. However, women who develop gestational diabetes are
more likely to develop type 2 diabetes later in life.

Symptoms of gestational diabetes


Gestational diabetes is usually diagnosed during routine screening. It often does not
cause any symptoms at all.
However, high blood glucose (hyperglycaemia) can cause some symptoms, including:

being thirsty

having a dry mouth

needing to urinate frequently

tiredness

recurrent infections, such as thrush (a yeast infection)

blurred vision

Causes of gestational diabetes


Diabetes is a condition where there is too much glucose (sugar) in the blood.
The amount of glucose in your blood is controlled by a hormone called insulin, which
is produced by the pancreas (a gland behind the stomach).
Diabetes is caused either by insufficient insulin being produced, or the body becoming
resistant to insulin, which means that the insulin does not work properly.

Insulin
When you eat, your digestive system breaks down food and the nutrients are absorbed into
your bloodstream. Normally, insulin is produced to take any glucose out of your blood and
move it into your cells. The glucose in your cells is then broken down to produce energy.

Gestational diabetes
During pregnancy, your body produces a number of hormones (chemicals), such as
oestrogen, progesterone, and human placental lactogen (HPL). These hormones make your
body insulin-resistant, which means your cells respond less well to insulin and the level of
glucose in your blood remains high.
The purpose of this hormonal effect is to allow the extra glucose and nutrients in your blood
to pass to the foetus (unborn baby) so it can grow.
In order to cope with the increased amount of glucose in your blood, your body should
produce more insulin. However, some women cannot produce enough insulin in pregnancy to
transport the glucose into the cells, or their body cells are more resistant to insulin. This is
known as gestational diabetes.

Risk factors
You may be at increased risk of gestational diabetes if:

your body mass index (BMI) is 30 or more you can use the healthy
weight calculator to work out your BMI
you have previously had a baby who weighed 4.5kg (10lbs) or
more at birth the medical term for a birth weight of more than 4kg
(8.8lbs) is macrosomic

you had gestational diabetes in a previous pregnancy

you have a family history of diabetes one of your parents or siblings


has diabetes

your family origins are South Asian (specifically India, Pakistan or


Bangladesh), black Caribbean or Middle Eastern (specifically Saudi
Arabia, United Arab Emirates, Iraq, Jordan, Syria, Oman, Qatar, Kuwait,
Lebanon or Egypt)

Diagnosing gestational diabetes


Every pregnant woman with one or more risk factors should be offered a screening test
for gestational diabetes.
Screening identifies otherwise healthy people who may be at increased risk of a condition,
such as diabetes. You can then be offered information and further tests to determine whether
you have the condition.

Screening
You may be screened for gestational diabetes at your booking appointment. This is the first
antenatal appointment with your midwife or GP, which takes place around weeks 8-12 of
your pregnancy. Read about antenatal appointments for more information about your care
during pregnancy.
At this time, your GP or midwife will find out if you are at increased risk of gestational
diabetes. They will do this by asking about any risk factors that may affect you, such as
whether you have a family history of diabetes.
Read about the causes of gestational diabetes for a full list of risk factors you will be asked
about.
If any one of these risk factors applies to you, you will be offered a test for gestational
diabetes.
Testing
Gestational diabetes is detected by using an oral glucose tolerance test (OGTT), usually at
24-28 weeks. For an OGTT, a sample of your blood will be tested, then you will be given a
glucose drink. Another sample of blood will then be taken two hours later to see how your
body is dealing with the glucose.
If you have had gestational diabetes in a previous pregnancy, the OGTT will be carried out at
16-18 weeks, followed by a repeat OGTT at 28 weeks if the first test is normal.

Complications of gestational diabetes


If gestational diabetes goes undetected, or is not managed effectively, it can cause
complications for both you and your baby.

Controlling your blood glucose (sugar) levels throughout your pregnancy reduces the risk of
complications.
Gestational diabetes may increase the risk of:

placental abruption the placenta (the organ that links the pregnant
womans blood supply to her unborn babys) starts to come away from the
wall of the womb (uterus). This may cause vaginal bleeding and/or
constant abdominal pain
needing to induce labour when medication is used to start labour
artificially (read about inducing labour for more information)

premature birth (see below)

macrosomia (see below)

trauma during the birth to yourself and your baby

neonatal hypoglycaemia your newborn baby has low blood glucose,


which can cause poor feeding, blue-tinged skin and irritability

perinatal death the death of your baby around the time of the birth

development of obesity and/or diabetes later in the baby's life

Premature birth
Gestational diabetes can cause premature birth (your baby being born before week 37 of the
pregnancy). This can lead to further complications for your baby, such as:

respiratory distress syndrome your babys lungs are not fully developed
and cannot provide enough oxygen to the rest of their body
jaundice your babys skin turns yellow when a waste product called
bilirubin builds up in the blood

Macrosomia
Gestational diabetes increases the risk of your baby being large for its gestational age, i.e.
weighing more than 4kg (8.8lbs). This is known as macrosomia.
Macrosomia occurs during the pregnancy because the excess glucose in the mothers blood is
passed to the foetus (unborn baby). This causes the foetus to produce insulin (a hormone) that
allows glucose to enter the cells, which results in growth.
Shoulder dystocia
Macrosomia can lead to a condition called shoulder dystocia. This is when your babys head
passes through your vagina, but your babys shoulder gets stuck behind your pelvic bone (the
ring of bone that supports your upper body, also called the hip bones).

Shoulder dystocia can be dangerous as your baby may not be able to breathe while they are
stuck. It is estimated to affect 1 in 200 births. For more information, see Royal College of
Obstetricians and Gynaecologists: shoulder dystocia.

Future conditions
Mother
After having gestational diabetes, you are around seven times more likely to develop type 2
diabetes than women who have had a normal pregnancy.
Type 2 diabetes is when your body does not produce enough insulin, or the bodys cells do
not react to the insulin (insulin resistance). read about type 2 diabetes for more information
about this condition.
Therefore, it is important your blood glucose is monitored after the birth to check whether or
not it returns to normal.
Baby
Your baby may also be at greater risk of developing these conditions in later life:

diabetes
obesity (having a body mass index of more than 30)

Future pregnancies
After having gestational diabetes, you are at increased risk of having gestational diabetes in
any future pregnancies.
It is very important to speak to your GP if you are planning another pregnancy. They may
arrange for you to monitor your own blood glucose from the early stage of your pregnancy.
Read about diagnosing gestational diabetes for more information

Treating gestational diabetes


Exercising for new mums
In this video, mothers discuss fitting exercise around a newborn baby and experts explain
what's safe to do after you've given birth.

After pregnancy
After you have given birth, any medication you were on to control your blood glucose will
usually be stopped immediately. Your blood glucose level will be tested about six weeks after
delivery to make sure it has returned to normal.
Your weight and waist measurement may be monitored and you should be given advice about
diet and exercise.

You should be aware of the symptoms of high blood glucose (hyperglycaemia), which could
be a sign your diabetes has returned. These are:

increased thirst
the need to urinate frequently

tiredness

Your fasting blood glucose will be measured (after you have not eaten for eight hours
normally first thing in the morning) at your six-week postnatal check.
This, or your HbA1c (a marker of your average blood sugar over the preceding 3
months) will then be measured at least once a year to check whether or not you
have developed type 2 diabetes.

Hypoglycaemia
Hypoglycaemia is an abnormally low level of glucose in the blood. You may be at risk of
hypoglycaemia if you are using insulin injections to control your gestational diabetes.
Be informed of the risks of hypoglycaemia, and learn how to recognise the symptoms, such
as:

feeling hungry
trembling or shakiness

sweating

anxiety or irritability

going pale

If hypoglycaemia is not treated it may lead to unconsciousness because there is not enough
glucose for the brain to function normally.
The immediate treatment of hypoglycaemia is to have some sugary food or drink, such as:

Lucozade
glucose tablets

fruit juice

You may be given a concentrated glucose solution (drink) to keep on hand in case you have
hypoglycaemia.
Read about Hypoglycaemia for more information.
If you have gestational diabetes, you will be advised about monitoring and controlling
your blood glucose (sugar) levels.
For many women, changing diet and more exercise will be enough to control your gestational
diabetes. Some women will need medication.

In addition, you will be taught how to monitor your blood glucose, and your unborn baby will
be closely monitored.

Monitoring blood glucose


Your GP, midwife, or diabetes team will discuss with you how to test your blood glucose
levels. They will also explain how blood glucose is measured, and what level you should be
aiming for.
Blood glucose levels are usually measured in terms of the amount of millimoles of glucose in
one litre of blood. A millimole is a measurement that defines the concentration of glucose in
your blood. The measurement is expressed as millimoles per litre, or mmol/l for short.
Your individual mmol/l target will be set for you. This may include a target for your:

fasting blood glucose (after you have not eaten for around eight hours
normally first thing in the morning)
postprandial blood glucose (one hour after you have eaten)

You will be advised when and how often you need to test your blood glucose. You may need
to test your fasting blood glucose and your blood glucose after every meal throughout your
pregnancy. If your diabetes is being treated with insulin (see below, under Medications), you
may need to test your blood glucose before going to bed at night.
Read about testing your glucose levels for more information about how to do this.

Diet
You may be advised to change your diet to control your gestational diabetes. You should be
referred to a dietician (a healthcare professional who specialises in nutrition) to advise on a
special diet.
Some advice you may be given is explained below.

Eat regularly
Don't skip meals. By eating regular, balanced meals which include a starchy carbohydrate
with a low Glycaemic Index (GI) you can absorb carbohydrate more slowly helping keep
your blood glucose levels stable between meals.
Choose from pasta, basmati or easy cook rice, grainy breads such as granary, pumpernickel
and rye, new potatoes, sweet potato and yam, porridge oats, All-Bran and natural muesli.
High fibre varieties of starchy foods will also help your digestive system and prevent
constipation.

GI Foods
The GI ranks food based on its effect on blood sugar levels with low GI foods absorbed into
the bloodstream slowly, and high GI foods absorbed quickly, causing blood sugar levels to
rise.

Don't get obsessed with GI ratings. Aim for a balanced and appealing diet, which you can
keep to over time. Think variety to get the full benefits of low GI foods.
Read about the Glycaemic Index at Diabetes UK for more information.

Eat more fruit and vegetables


Aim for at least five portions a day to provide vitamins, minerals and fibre but keep to one
portion of fruit at a time. And try to include beans and lentils such as kidney beans, butter
beans, chickpeas or red and green lentils. Sound advice and tasty recipes are available from
Diabetes UK.

Limit sugar and sugary foods


You don't need to eat a sugar-free diet. Sugar can be used in foods and in baking as part of a
healthy diet, but use it sparingly. Drinking sugar-free, no added sugar or diet colas or
squashes, instead of sugary versions can reduce the sugar in your diet.
You may also be advised to choose lean (not fatty) proteins, such as fish. Eat two portions of
fish a week, one of which should be oily fish, such as sardines or mackerel. There are some
fish you should avoid, for example, eating too much tuna. Read about foods to avoid in
pregnancy for more information.

Unsaturated fats
Aim to eat a balance of polyunsaturated and monounsaturated fats. Small amounts of
unsaturated fat will keep your immune system (the bodys defence system) healthy and can
reduce cholesterol levels (cholesterol is a fatty substance that can build up in your blood and
seriously affect your health).
Foods that contain unsaturated fat include:

nuts and seeds


avocados

spreads made from sunflower, olive and vegetable oils

Calories
If your body mass index (BMI) was more than 27 before you became pregnant, you may be
advised to reduce the amount of calories in your diet. You can use the healthy weight
calculator to work out your BMI but remember to use your pre-pregnancy weight.
Your GP, midwife, or diabetes team will advise how many calories you should eat a day, and
the safest way to cut out calories from your diet.

Exercise

Physical activity lowers your blood glucose level, so regular exercise can be an effective way
to treat gestational diabetes. Your GP, midwife, or diabetes team will advise about the safest
way to exercise during pregnancy. Read about exercise in pregnancy for more information.
If your body mass index (BMI) was more than 27 before you became pregnant, you may be
advised to take moderate exercise for at least 150 minutes (2 hours and 30 minutes) every
week. This can be any activity that gets you slightly out of breath and raises your heart rate,
such as cycling or fast walking.

Medication
If diet and exercise have not effectively controlled your gestational diabetes after around one
to two weeks, you may be prescribed medication. The timing may vary depending on your
glucose levels.
There are several different types of medication available, and the choice will depend on:

what will most effectively control your blood glucose


what is acceptable to you

Possible medicines include:

Insulin
Metformin and glibenclamide in tablet form

These are explained in more detail below. These medicines will be stopped immediately after
the birth of your baby.

Insulin
If you are insulin resistant (your body does not respond to insulin), you may need insulin
injections to ensure your body has enough insulin to lower your blood glucose levels.
Insulin must be injected because if you swallowed it, the enzymes (proteins that speed up and
control chemical reactions in the body) in your stomach would digest it like a food, and it
would not be effective. If you need insulin injections, you will be shown:

how and when to inject yourself


how to store your insulin and dispose of your needles properly

Insulin comes in several different preparations.You may be prescribed:

Rapid acting insulin analogues (aspart or lispro) these are normally


injected before or just after meals; they work quickly but do not last long
Basal insulin (insulatard or lantus) these are normally injected at bedtime
or on waking; they provide the background insulin required to keep blood
glucose levels stable between meals

These are safe to use during pregnancy. However, you will need to monitor your blood
glucose closely. If you are being treated with insulin, you will need to check your:

fasting blood glucose (after you have not eaten for around eight hours
normally first thing in the morning)
blood glucose, one hour after every meal
blood glucose at other times (for instance if you feel unwell or have been
having episodes of hypoglycaemia low blood glucose)

If your blood glucose falls too low, you may have hypoglycaemia (see the box, left).

Oral hypoglycaemic agents


In some cases, you may be prescribed oral hypoglycaemic agents alongside or instead of
insulin. These are medicines you swallow to lower the level of glucose in your blood. The
two that can be used during pregnancy are:

metformin
glibenclamide (from week 11 of the pregnancy)

Both metformin and glibenclamide can cause side effects, including:

nausea (feeling sick)


vomiting

diarrhoea (passing loose, watery stools)

As with insulin, if you are using glibenclamide you may be at risk of hypoglycaemia (see
box, left). This does not usually happen with metformin unless it is used in combination with
insulin or glibenclamide.
For a full list of side effects, see the patient information leaflet that comes with your
medicine.

Monitoring your unborn baby


If you have gestational diabetes, your unborn baby may be at risk of complications, such as
being large for the state of pregnancy. Because of this, you may be offered extra antenatal
appointments so your baby can be closely monitored during your pregnancy.
Appointments you may be offered include:

an ultrasound scan around weeks 18-20 of your pregnancy to check your


unborn babys heart for any signs of abnormalities (if your gestational
diabetes is diagnosed late into your pregnancy you may not be offered this
scan)
an ultrasound scan at weeks 28, 32, 36 and regular checks from week 38
of the pregnancy to monitor your babys growth and the amount of
amniotic fluid (the fluid that surrounds them in the womb)

The birth

If you have gestational diabetes and your baby is growing at a normal rate, you may be
offered the chance to start labour (the process of giving birth) after week 38 of pregnancy.
This can be done by inducing labour. This is when labour is started artificially by inserting a
pessary (tablet) or gel into your vagina, and a hormone drip in your arm (read about inducing
labour for more information).
You can wait for labour to start naturally as long as your blood sugars are within normal
levels, the ultrasound scans of the baby are normal, and there is no other problem in
pregnancy.
If your baby is large for its gestational age (macrosomic), then your doctor or midwife should
discuss the birth options with you.
Normal delivery is usually still possible but will depend on the size of the baby.
You should give birth at a hospital where healthcare professionals trained in resuscitating
newborn babies are available 24 hours a day.
During labour and the birth, your blood glucose will be measured every hour and
kept between 4 to 7 mmol/l. If you have been on insulin during pregnancy, you will be
recommended to have an intravenous drip of insulin as well as glucose during labour, to
allow careful control of your blood sugar levels.
Around two to four hours after the birth, your newborn babys blood glucose will also be
measured, this will usually be before the babys second feed.