Diabetes and Pregnancy: Risk and Treatment

Diabetes and Pregnancy - Diabetes that develops during pregnancy is known as gestational diabetes. It usually starts in the middle or towards the end of your pregnancy, rarely before 20 weeks of pregnancy. It occurs because your body cannot produce enough insulin to meet its extra needs in pregnancy. It may start earlier in pregnancy if you already have problems with your blood glucose levels.

Your healthcare team should give you information about gestational diabetes and how it may affect you and your baby before offering to check for gestational diabetes.

Checking for gestational diabetes during pregnancy 

Certain characteristics can indicate that some women are more likely than others to develop gestational diabetes during their pregnancy. At your booking appointment your healthcare team will check if:

•  you are overweight (body mass index or BMI 30 kg/m² or higher)
•  you have given birth to a large baby before (weighing 4.5 kg or more)
•  you have had gestational diabetes before
•  you have a parent, brother or sister with diabetes
•  your family origin is South Asian, black Caribbean or Middle Eastern (these groups have a higher risk of developing gestational diabetes).

If you have any of these characteristics, you should be offered a test for gestational diabetes. If you have had gestational diabetes before, you should be offered a kit to check your own blood glucose levels early in pregnancy or a test called an oral glucose tolerance test (sometimes shortened to OGTT or GTT) at 16 to 18 weeks (plus an OGTT at 28 weeks if the first test is normal) to check for gestational diabetes. An OGTT involves a blood test before breakfast, then again 2 hours after a glucose drink. You should be given an OGTT at 24 to 28 weeks if you have any of the other characteristics.

If you have been diagnosed with gestational diabetes 

Women with diabetes are at risk of serious health problems for themselves and their babies. Your healthcare team should discuss the risks with you and explain that they can be reduced if your blood glucose levels are well controlled.

If you have gestational diabetes, you may be at risk of:

• having a large baby, which increases the likelihood of birth problems, having your labour induced and caesarean section

• having a miscarriage.

Your baby may be at risk of:

• dying during birth
•  health problems following birth that may require hospital care
•  developing obesity and/or diabetes in later life.

Planning your pregnancy if you have had gestational diabetes before

Talk to your healthcare team if you are planning to become pregnant and have had gestational diabetes before. Your healthcare team should explain that you are at risk of having diabetes in pregnancy again and offer you a test for diabetes. If you become pregnant again, you should be offered a kit to check your own blood glucose levels early in pregnancy or be offered an OGTT at 16 to 18 weeks (plus an OGTT at 28 weeks if the first test is normal) to check for gestational diabetes.

Your healthcare team should give you advice and information about gestational diabetes and how to stay healthy during your pregnancy. This should include:

 the risks for you and your baby

•  how to check your own blood glucose level and what your ideal blood glucose level should be

• choosing foods that will help to keep your blood glucose at a healthy and stable level

•  information about how to lose weight by changing your diet and taking exercise if you are overweight.

If your blood glucose does not reach a satisfactory level after 1 to 2 weeks, or if an ultrasound scan shows that your baby is large, you may need to take tablets or give yourself insulin injections.

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