Are you high risk for Gestational Diabetes?
This month I’m taking a close look at Gestational Diabetes (GD), a condition that can affect up to 1 in 5 mums-to-be, can have serious consequences and can go undiagnosed in 10% of cases.
So what is Gestational Diabetes? It is diabetes that develops in women who were not diabetic before, usually in the middle or towards the end of pregnancy and usually disappears after giving birth.
It happens when your body cannot produce enough insulin – a hormone that helps control blood sugar levels – to meet your extra needs in pregnancy. This causes high blood glucose levels and the excess glucose is passed on to your growing baby, who gains extra weight. This can lead to complications for both you and your baby during birth.
The good news is that being diagnosed means your blood sugar levels can be monitored and lowered, reducing the risks.
Who gets Gestational Diabetes?
Gestational Diabetes affects up to 18 in 100 pregnancies in the UK and there are known risk factors. Your GP/antenatal hospital team should offer you a test for it if any of these apply to you:
- you are overweight or obese (BMI of 30 or above)
- you’ve had Gestational Diabetes before
- in a previous pregnancy you’ve had a very large baby – 4.5kg/10lb or more
- you have a family history of diabetes – parent or sibling
- your background is South Asian, Black or African Caribbean or Middle Eastern (even if you were born in the UK).
A study for the charity Gestational Diabetes UK – which has some excellent resources – found that although the condition is often linked to obesity, 52% of the women polled did not have a BMI greater than 30. What’s more, 10% did not have any of the commonly used risk factors at all.
This data prompted Gestational Diabetes UK to call for screening for all mums-to-be, not just those who are overweight or in one of the other risk categories.
Why is Gestational Diabetes dangerous?
Most women who develop diabetes in pregnancy have healthy pregnancies and healthy babies but occasionally there are serious problems, especially if Gestational Diabetes goes unrecognised.
If your blood glucose is too high, your baby will produce more insulin and grow bigger, which increases the chances of having your labour induced, a caesarean section, serious birth problems (such as shoulder dystocia, when your baby’s head passes through your vagina but their shoulder gets stuck behind your pelvic bone) and even stillbirth.
The risk of stillbirth increases by 44% in women who are at risk of Gestational Diabetes but not screened and there is a four-fold greater risk of stillbirth in women with raised fasting levels who are not diagnosed, according to a recent UK study.
The study found that women who were screened and diagnosed had no increase in stillbirth.
This prompted Gestational Diabetes UK to note: “Anyone who is under the assumption that gestational diabetes will ‘just cause a bigger baby… chubby babies are cute, bouncy babies!‘ and that this is the only concern, should learn about the associated complications. There is a difference between a larger-sized baby and a baby who is swollen and very poorly as a result of undiagnosed or poorly controlled blood sugar levels.”
What can you do?
- You can reduce your risk of developing Gestational Diabetes by managing your weight, eating healthily and keeping active before pregnancy.
- In the UK, all pregnant women considered at risk are offered a Gestational Diabetes test during pregnancy.
- According to NICE (National Institute for Health and Care Excellence) guidelines, all those who test positive should be referred to a dietitian and advised to take regular exercise (such as walking for 30 minutes after a meal) to improve blood glucose control.
- You'll be given a blood sugar testing kit so you can monitor the effects of treatment. You will be advised to test blood sugar levels regularly and will be referred for additional appointments at hospital, alongside additional ultrasound scans.
- You may be among the 1 in 5 women who need to take tablets and/or have insulin injections to control their blood glucose. A specialist diabetes nurse will show you how to inject yourself with insulin, how often to do it and when you should check your blood glucose levels.
- You may be advised to have your baby earlier than planned and in a hospital setting under the care of a consultant.
What about a future pregnancy?
You can reduce your risk of developing Gestational Diabetes again by being the right weight for your height (having a normal BMI), eating a healthy diet and taking regular physical exercise before you become pregnant. As soon as you become pregnant, contact your GP, practice nurse or hospital antenatal team for advice about your care.
Finally, I endorse this advice from the website diabetes.org.uk: “I’d really recommend newly diagnosed mums speak to other mums with, or who’ve had, gestational diabetes, if they can. The moral support really helps.”
 Published in BJOG (British Journal of Obstetrics and Gynaecology), 19 March 2019: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.15659