Gestational diabetes

If gestational diabetes is not managed properly or goes undetected/undiagnosed, it could cause a range of serious complications for both you and your baby:

• Macrosomia – your baby being large for its gestational age i.e. weighing more than 4kg (8.8lbs) This is the most commonly known complication of gestational diabetes.  Macrosomia increases the need for induced labour or a caesarean birth, and may lead to birth problems such as shoulder dystocia (see below)
• Shoulder dystocia – Macrosomia can lead to a condition called shoulder dystocia. This is when your baby’s head passes through your vagina, but your baby’s shoulder gets stuck behind your pelvic bone. Shoulder dystocia can be dangerous, as your baby may not be able to breathe while they are stuck. It’s estimated to affect 1 in 200 births. Following shoulder dystocia deliveries, 20% of babies will suffer some sort of injury, either temporary or permanent. The most common of these injuries are damage to the brachial plexus nerves, fractured bones, contusions and lacerations, and birth asphyxia.
• Premature birth (your baby being born before week 37 of the pregnancy) – This can lead to complications such as newborn jaundice or respiratory distress syndrome (RDS).
• Health problems shortly after birth that require hospital care – such as newborn hypoglycaemia (low blood sugar) and/or newborn jaundice
• Miscarriage – the loss of a pregnancy during the first 23 weeks
• Stillbirth – the death of your baby around the time of the birth

There are certain risk factors that may make some women more likely to develop GDM. These include:

• A previous pregnancy with GDM
• First degree relative (parent or sibling) with diabetes (type 1 or type 2)
• Polycystic ovarian syndrome (PCOS)
• Obesity (BMI greater than 30kg/m2)
• Large baby on scan/previous large baby (macrosomia – birth weight greater than 4.5kg)
• Previous unexplained stillbirth or neonatal death
• Ethnicity – Afro-Caribbean, South East Asian and Middle Eastern ethnic groups of women are more likely to develop GDM

Good blood glucose control reduces the risks of complications developing for the mother and baby.

The target HbA1c for mothers before and during pregnancy is 6.1% (or 43 mmol/mol). 

People with diabetes before their pregnancy will be advised to keep excellent control of their blood sugar before and throughout the pregnancy.

The first eight weeks of the pregnancy are a critical period and so it is highly recommended that strong control is achieved prior to becoming pregnant wherever possible.

Mothers who develop gestational diabetes will be treated initially with diet and exercise but may be put onto oral hypoglycaemics (tablets) or insulin injections if blood sugar levels remain high.

The targets (as per NICE guidelines) for your blood glucose levels during pregnancy are:

• fasting blood sugar below 5.3mmol /L
• 1 hour after meals below 7.8mmol/L
• 2 hours after meals below 6.4mmol/L

The following advice applies, unless you are told otherwise by your Diabetes Team:

• If you are treating your GDM with diet and exercise and/or with oral therapy (metformin) without insulin, please test your fasting and 1 hour post meal blood glucose levels daily
• If you are treating your GDM with insulin injections, please test your fasting, pre meal, 1 hour post meal and bed time blood glucose levels daily

We promote the approach that looks at our 4 pillars of health – Food, Movement, Sleep and Stress management. Mothers with young children or babies are often exhausted with taking care of the family and sometimes trying to hold down a job as well. Looking after themselves is not a priority for many women.

Food

We encourage everyone to minimise consumption of processed foods especially ultra-processed food. Focus on real food which is nutrient dense (which means that it gives you the micronutrients that your body needs to function properly).

Movement

Regular movement throughout the day and getting as strong as possible is critical for metabolic health and diabetes prevention.

Sleep

Sleep is the tide that raises all health boats. This can be especially challenging for mothers with young children and babies but it is fundamental for all aspects of health.

Stress management

Managing stress can sometimes be the hardest of the 4 pillars to tackle. However chronic stress raises your stress hormones which can make it hard to lose weight and manage your blood glucose properly.

If you would like to learn more about diabetes prevention and get support with this, we run group education sessions as well as health coaching sessions at Aspen Medical Practice.

Visit our Diabetes and prediabetes group session page to find out more. If you would like to attend the group sessions, please email aspen.diabetes@nhs.net.