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Diabetes in pregnancy

Published by Bupa's health information team, January 2008.

This factsheet is for women who want to know more about diabetes that develops in pregnancy (gestational diabetes). It doesn't give advice for women who already have diabetes and would like to become pregnant.

Diabetes can develop during pregnancy in a woman who hasn't previously had the condition. This is called gestational diabetes, and it affects around two percent of pregnant women. It can lead to problems for the mother and baby if it isn't properly controlled.

About gestational diabetes
Symptoms of gestational diabetes
Causes of gestational diabetes
Diagnosis of gestational diabetes
Treatment of gestational diabetes
Prevention of diabetes
Questions and answers
Related topics
Further information
Sources

About gestational diabetes

Diabetes is a condition in which the blood sugar level is high because there isn't enough insulin, or insulin isn't working properly. Insulin is a hormone that enables your body to break down sugar (glucose) in your blood to be used as energy.

During pregnancy, various hormones block the usual action of insulin. This helps to make sure your growing baby gets enough glucose. Your body needs to produce more insulin to cope with these changes. Gestational diabetes develops when your body can't meet the extra insulin demands of the pregnancy.

Gestational diabetes usually begins in the second half of pregnancy, and goes away after the baby is born. If gestational diabetes doesn't go away after the baby is born, it's possible that you already had diabetes and that it was picked up during your pregnancy. The other forms of diabetes, called type 1 diabetes and type 2 diabetes, are life-long conditions.

Symptoms of gestational diabetes

Gestational diabetes doesn't usually cause any symptoms. However, sometimes you may have symptoms of high blood sugar, such as:

increased thirst
needing to urinate frequently
tiredness

However, these are also common symptoms in normal pregnancy.

Gestational diabetes isn't an immediate threat to your health. However, poorly controlled diabetes in pregnancy puts you at a higher risk of various problems. These include:

a condition called pre-eclampsia, which causes high blood pressure
premature labour
having too much amniotic fluid

You are also more likely to develop gestational diabetes in future pregnancies, and are at a higher risk of developing type 2 diabetes later in life.

For your baby

Having high blood sugar can cause your baby to grow larger, which can make delivery difficult. This can cause problems for both you and your baby. Sometimes a caesarean delivery is needed. You are more likely to have a caesarean delivery than women who don't have diabetes.

Your baby may have low blood sugar (hypoglycaemia) after birth. This is because your baby makes extra insulin to respond to your high blood sugar levels. Shortly after birth, your baby may continue to make extra insulin causing his or her blood sugar level to be too low.

If you had gestational diabetes, your newborn baby's blood sugar level will be checked regularly. Regular normal feeding, either breastfeeding or formula milk, may be enough to correct your baby's low blood sugar. But sometimes babies are given sugar (dextrose) solution through a drip (directly into a vein). Doctors will check your baby's blood sugar levels regularly.

Your newborn baby is at risk of jaundice (yellowing of the skin and whites of the eyes). This isn't serious and usually fades without the need for medical treatment.

There is an increased risk that your baby will be born with congenital problems, such as a heart defect. Sometimes, babies can be born with respiratory distress syndrome, in which the baby has problems breathing because his or her lungs have not matured normally. This usually clears up with time, although it may mean that the baby needs to be ventilated with a machine.

There is also a slightly higher chance of stillbirth or death as a newborn, but this is rare as long as glucose levels in both you and your baby after birth are well controlled.

There is an increased risk of the baby becoming obese as a child, although this may be due to the family's eating habits rather than any effect on the baby in the womb.

Causes of gestational diabetes

No-one knows why some women develop gestational diabetes and others don't, but you are more at risk if you:

have a family history of gestational diabetes (ie mother, grandmother or sister had it)
you have previously given birth to a large baby (weighing over 4.5kg/9lb 14)
you have previously had a stillbirth
are overweight or obese
have polycystic ovary syndrome (PCOS)

Diagnosis of gestational diabetes

One way to diagnose gestational diabetes is with a glucose tolerance test, which needs to be carried out in the morning, after you have eaten nothing overnight. Your doctor will give you a solution of glucose to drink and take blood samples at different intervals to see how your body deals with the glucose over time.

You will be offered a glucose tolerance test if you are at high risk of developing gestational diabetes (see Causes).

There is not enough evidence to support testing every pregnant woman to identify a high risk of diabetes, so the National Institute for Health and Clinical Excellence (NICE) doesn't recommend routine screening. But some doctors and midwives test urine for sugar at antenatal visits and may offer a glucose tolerance test if they are concerned about diabetes.

Treatment of gestational diabetes

Your doctor will refer you to a specialist clinic where the doctors and nurses are experienced in looking after pregnant women with diabetes. You will need to have more frequent antenatal appointments than women without gestational diabetes.

It's important that you control your blood sugar level if you have been diagnosed with gestational diabetes. This means regular testing of your blood sugar (glucose) levels, a carefully planned diet and keeping active.

Your doctor at the specialist clinic will give you advice on how to test, how often to do it, and the blood sugar results that you are aiming for. You will probably need to do a test every day.

Your doctor or a specialist dietician will give you advice about what to eat. A meal plan will probably consist of a variety of foods, including plenty of starchy foods such as wholemeal bread, pasta, rice and potatoes, and at least five portions of fruit and vegetables each day.

Regular moderate intensity exercise, such as walking or cycling, can help reduce blood sugar levels and promote a sense of well being. At least 30 minutes of activity that gets you slightly breathless each day is recommended by the Department of Health.

Medicines

It's possible that your blood sugar levels will stay too high even if you make lifestyle changes. You may need daily injections of insulin if this happens. Your doctor or specialist nurse will teach you how to do this.

It's possible to have too much insulin and this can cause low blood sugar (hypoglycaemia). Common symptoms of this are paleness, shaking, hunger and sweating. Your doctor or specialist nurse will explain how to recognise the symptoms of hypoglycaemia, and what to do if it happens. For example, keeping a sugary soft drink handy is a good idea.

Occasionally, low blood sugar can cause you to lose consciousness, and you will need an injection if this happens.

It's a good idea for your family and friends to know what to do if your blood sugar gets very low and you pass out.

After your baby is born

Your doctor or nurse will monitor the blood sugar levels of you and your baby after the birth. Diabetes UK recommend that it's best to breastfeed your baby within one hour of delivery.

Prevention of diabetes

Healthy lifestyle choices reduce the risk of you getting type 2 diabetes if you had gestational diabetes. Aim to eat a balanced diet, take regular exercise and maintain the correct weight for your height.