Diabetes in pregnancy: what you need to know!

 

Around 10-15 % of women will have diabetes in pregnancy.  Some women have diabetes before they fall pregnant (Type I or Type 2 diabetes).  Women can also develop diabetes for the first time during pregnancy (gestational diabetes).

 

What are the different types of diabetes in pregnancy?

  • Type 1 diabetes: Your insulin-producing cells are damaged.  Your body stops making insulin.  Patients need insulin injections for the rest of their lives.
  • Type 2 diabetes: Your body slowly stops responding to insulin, or it can’t produce enough insulin to keep up with your needs.  Type 2 usually affects adults.  It runs in families, but there is a big lifestyle component.  Type 2 diabetes is managed with a combination of healthy eating, exercise and medication.
  • Gestational diabetes: a type of diabetes that appears for the first time during pregnancy and goes away after the baby is born.  It’s caused by hormonal and metabolic changes in pregnancy.  Treating GDM reduces the risk of complications that can affect both mother and baby.

Dr Colin WEalsh Diabates pregnancy

How common is gestational diabetes (GDM)?

GDM affects 12-14% of pregnant women in Australia.

 

Who is more likely to develop GDM?

  • Aged 40 and over
  • Overweight
  • Had GDM in a previous pregnancy
  • Had high blood sugar levels or insulin resistance in the past
  • Has PCOS
  • Family history of diabetes
  • Previously given birth to a baby weighing 4.5kg or more
  • Taking some kinds of medication e.g. steroids

 

Diagnosing GDM

GDM is diagnosed with a “glucose tolerance test.”  You need to fast overnight before the test.  When you arrive, the lab will check your fasting blood sugar level and then give you a sweet drink.  Your blood sugar is re-tested after one and two hours.  (We don’t recommend the old-fashioned one-hour, non-fasting “challenge” test anymore).

 

What happens if I develop GDM?

It’s natural to be anxious if you are diagnosed with GDM.  However, there are simple ways to manage your blood sugar.  Most women go on to have a healthy pregnancy and a healthy baby.  Remember, it’s undiagnosed GDM that is most likely to cause problems.

The first step is to see a diabetes educator/dietitian.  The educator will teach you to monitor your blood sugar and help you with a healthy eating plan.  Regular exercise is also very important.  Most women will be able to manage their blood sugar with a diabetes diet and exercise.

Other women will find that, despite their best efforts, their blood sugars stay too high.  These women need to see an endocrinologist (a hormone specialist) and start insulin injections.

 

What about later in life?

Although GDM disappears within a few months of baby being born, women who had GDM have a higher chance of developing Type 2 diabetes later in life.  Your GP should screen you regularly for Type 2 diabetes as you get older.

 

How will diabetes affect my pregnancy and my baby?

Diabetes in pregnancy can lead to several complications, such as miscarriage, fetal abnormalities, fetal growth problems, stillbirth and difficulties during labour and delivery.  Your own level of risk will depend on two things:

  1. How long you’ve had diabetes.  Women with pre-pregnancy diabetes (Type 1 & 2) have a higher risk of complications compared to women with GDM.
  2. How well you are able to control your blood sugar levels throughout pregnancy.  There is very good evidence showing us that good control of diabetes in pregnancy improves outcomes for both mother and baby.

 

Who looks after diabetic women during pregnancy?

Most obstetricians are happy to look after patients who develop gestational diabetes.  However, pre-pregnancy diabetes puts a pregnancy at much higher risk.  Type 1 diabetics and Type 2 diabetics on insulin should see an experienced high-risk obstetrician or a Maternal-Fetal Medicine specialist.

Women with diabetes in pregnancy need a lot of support.  Often, extra consultations with a dietitian and an endocrinologist will be recommended.