Finding out you have gestational diabetes can be very frightening. Not only do you have to deal with all the emotions (the ups and the downs) and the questions that come with being pregnant, but also the uncertainty of this new-found condition. Fortunately, as with all types of diabetes, there are many well-informed health professionals to help answer your questions and to guide you through this very important time in your life. The more you know, the easier it is to accept and make the necessary changes for a successful and happy pregnancy. Let’s first review how you got here.
Somewhere between 24 and 28 weeks into your pregnancy your doctor most likely sent you to be screened for the presence of gestational diabetes. (If you were at greater risk for getting gestational diabetes, your doctor may have sent you earlier, at 16 weeks.) You may think this is too late in your pregnancy to be finding out about such a problem, but in most cases, screening before this time would be of little value. It is the hormonal changes (hormones made by the placenta that resist insulin) in the second and third trimesters of pregnancy, along with the growth demands of the fetus, that increase a pregnant woman's insulin needs by two to three times that of normal.
Insulin is needed to take the sugar from your blood and move it into your cells for energy. If your body cannot make this amount of insulin, sugar from the foods you eat will stay in your blood stream and cause high blood sugars. This is gestational diabetes.
Gestational diabetes means diabetes mellitus (high blood sugar) first found during pregnancy. It occurs in three to five percent of all pregnancies (in other words, one in 20 pregnant women will develop gestational diabetes); so, you can take comfort in the fact that you are not alone.
In most cases, gestational diabetes is managed by diet and exercise and goes away after the baby is born. Very few women with gestational diabetes require insulin to control this type of diabetes. If you do need insulin, it will ensure blood glucose stays in the acceptable range, thereby reducing the risks to you and your baby.
Gestational diabetes should not be taken lightly. Immediate risks to the mom and the fetus are very real; however, these risks can be minimized with good care and follow up.
Ante-natal care should be hospital-based, from a multi-disciplinary team
Individualise insulin regimens and recommend 4-times daily glucose monitoring.
Aim to maintain glucose 4-7 mmol/L and HbA1c within the normal non-diabetic range.
Remember insulin requirements increase progressively from the 2nd trimester until the last month of gestation, when a slight fall-off may be noted
Hypoglycaemia and loss of awareness is common in early pregnancy. Hypoglycaemia does not appear to have long-term adverse effects on fetal development
Ketoacidosis can cause fetal death at any stage. All women should test urine for ketones if blood glucose is high, if vomiting occurs or if they are unwell.
The timing of delivery is individualised; in women with good diabetes control and no complications, the pregnancy may be continued to 39-40 weeks.
Caesarian section rates are often higher than in non-diabetic women.
Insulin requirements fall dramatically after delivery, therefore reduce insulin doses.immediately to pre-pregnancy levels, to avoid hypoglycaemia.
Encourage slightly higher blood glucose levels than during pregnancy.
In breast-feeding mothers, reduce insulin dose further once lactation is established.
Discuss contraception while the patient is still in hospital.
All women should be seen by the diabetes pregnancy care team six weeks after delivery.