Gestational diabetes

About 4-5% of all women develop diabetes during pregnancy. During pregnancy, your body produces hormones that can make insulin less effective, which means the body will begin producing more insulin to keep blood sugar levels normal. If your body cannot produce enough insulin, then you will develop diabetes.

High blood sugar levels can affect both you and your baby during pregnancy. Gestational diabetes often has no symptoms.

Impact on your pregnancy

Gestational diabetes slightly increases the risk of developing high blood pressure, pre-eclampsia, too much amniotic fluid or preterm birth. Gestational diabetes can be treated with diet and exercise. However, some patients will need to be treated with insulin.

Diet

You will be offered a consultation with a dietician, who can help you plan your diet. The right diet can help keep your blood sugar from getting too high.

Exercise

Exercise can also help keep your blood sugar at normal levels. We recommend at least 30 minutes of exercise every day. The exercise can be in the form of walks, bike riding or swimming.

Treatment using insulin

If diet and exercise do not help keep your blood sugar at normal levels, then it will be necessary to use insulin. Thirty percent of women with gestational diabetes will need insulin.

Measuring your blood sugar

You will need to keep an eye on your blood sugar throughout your pregnancy. You will be given a device that measures your blood sugar. You will need to measure your blood sugar 6 times a day during the first week:

• Before breakfast.
• 1½ hours after you started eating breakfast.
• Before lunch.
• 1½ hours after you started eating lunch.
• Before dinner.
• 1½ hours after you started eating dinner.

Your blood sugar level before meals should be under 6.0 mmol/L. After meals it should be under 8.0 mmol/L.

After the first week, we will use the measurements to make a plan for how often you need to check your blood sugar through the remainder of your pregnancy.

Extra check-ups

When you have gestational diabetes, you will be offered several extra check-ups during your pregnancy at your general practitioner and a specialist midwife. The consultations will focus on the well-being of you and your baby. Together we will draw up a plan for the remainder of your pregnancy and delivery.

How gestational diabetes affects the baby

When your blood sugar increases so does the blood sugar of your baby. It is not healthy for your baby to have high blood sugar for a prolonged period of time. If you have gestational diabetes, your baby may be at increased risk of:

Excessive birth weight

If your blood sugar level is higher than average during pregnancy, it can cause your baby to grow too large, which may lead to problems after delivery. The baby can also grow less than usual. We can provide additional ultrasounds every 2 to 6 weeks. In some cases we recommend inducing delivery. We will discuss this with you.

Jaundice

Gestational diabetes can result in a slightly increased risk of your baby developing jaundice. Jaundice often develops 3 to 5 days after birth and will in some cases need to be treated with light therapy.

Low blood sugar

Your baby might have low blood sugar during the first few days after birth if you had gestational diabetes. The baby would have produced excess amounts of insulin during pregnancy, and it can take several hours before insulin levels go back to normal after delivery.

We will measure the baby's blood sugar 2 hours after birth. Some people are able to go home immediately after delivery. Other times we recommend staying in hospital for an additional 24 hours. The best way to treat low blood sugar is by breastfeeding or giving the baby milk in a cup. You can begin expressing milk by hand at the end of the pregnancy, so you have enough milk ready for your baby. You can talk to the midwife about this.

After giving birth

Diet

We recommend that you stick to the healthy diet you adopted during pregnancy. You can also speak to your general practitioner about a healthy lifestyle.

Measuring your blood sugar

We recommend that you measure your blood sugar 2 hours after delivery. If your blood sugar level is under 12 mmol/L, you will not need to check your blood sugar again. The majority of women experience that their blood sugar levels return to normal shortly after birth.

Preventing type 2 diabetes

Gestational diabetes increases the risk of developing type 2 diabetes. Fifty percent of all women who have gestational diabetes will develop type 2 diabetes later in life.

You can even help prevent type 2 diabetes by

• exercising at least 30 minutes every day
• eating a healthy diet
• losing weight if you are overweight.

Breastfeeding your baby can also have a preventive affect.

Check-ups

In the vast majority of cases, gestational diabetes will go away by itself after you have given birth. However, we recommend that you book an appointment for a check-up at your general practitioner 2-3 months after delivery, and then once a year to check whether you are developing type 2 diabetes.