Pregnant women have been identified by the UK government as being at higher risk of severe illness if infected with coronavirus. Some pregnant women have additional medical health issues, such as diabetes, during their pregnancy which require additional maternal monitoring in order to optimise pregnancy outcome.
The RCOG – Royal College of Obstetricians & Gynaecologists - have issued guidance for teams caring for women with diabetes during their pregnancy.
The main emphasis of the document is to maintain good care whilst minimising risk from coronavirus (COVID-19). The best way to minimise coronavirus (COVID-19) infection risk is strict social distancing and self isolation if appropriate.
Using the RCOG guidance we are trying to minimise Face to Face (F2F) as much as possible, and promote virtual care wherever possible. To help achieve this, the diabetes in pregnancy team have put together the following resources. Please ensure you go through all the information on this page carefully.
Please be aware that information is changing rapidly, and so guidance may also change rapidly. You may find that this information doesn’t fit your circumstances as an individual perfectly – please ask the team if you are unsure.
We also strongly recommend that you sign up for the electronic patient portal at Addenbrooke’s and The Rosie hospitals which will allow you to assess part of your health records – especially appointments, tests results and letters.
For more information visit our MyChart page. Please contact us if you wish to sign up .
You have recently received a diagnosis of Gestational Diabetes and no doubt are keen to know what this means for you, your pregnancy and what you can do to manage it.
Please go through each of the sections below carefully. View the videos and read any attached files as they all contain important information to help you understand gestational diabetes and get you started on managing it effectively.
There is vital information on how to stay in touch with us and the additional support you will receive in this pregnancy. If you have any questions or concerns please get in touch with us.
What is Gestational Diabetes?
Gestational diabetes is diabetes that occurs in pregnancy. The blood glucose levels in your blood run at higher levels than normal during pregnancy. This is important as the higher blood glucose levels cross the placenta to your baby. This can affect the outcome of your pregnancy.
For a brief overview of Gestational Diabetes and how it is managed please see the video below:
Video: Gestational diabetes – what it means for your care (opens in a new tab)
If you are unable to view the video – Gestational diabetes – what it means for your care transcript (opens in a new tab)
Why do I have Gestational Diabetes?
You received this diagnosis as your recent blood tests suggest that your body has not fully been able to regulate your blood glucose levels to the normal range during this pregnancy.
Please be assured you have not caused this diagnosis in any way, for example by eating sugary foods in this pregnancy.
You were tested for gestational diabetes based on risk factors. The outcome of the tests is reflective of these risk factors and other pregnancy-related factors, many of which are beyond your control.
How do I manage Gestational Diabetes?
The aim of managing gestational diabetes is to keep your blood glucose levels in the normal range and allow your baby to grow at the correct rate as well as keep your baby’s blood glucose levels stable after delivery.
We cannot overemphasize how important diet and activity are in managing gestational diabetes. Please take extra care reading the sections below and try to incorporate as many principles as possible to help you achieve your blood glucose targets.
Waking/ fasting blood glucose ≤5.3 mmol/l
1 hour post meal glucose ≤7.8 mmol/l
Average 14 day glucose <6 mmo/l
As highlighted in the video above the 3 basic steps to managing gestational diabetes are:
- Blood glucose measurement (opens in a new tab)
- Dietary advice for gestational diabetes
- Activity for gestational diabetes
Additional tools to support you with the diet and activity measures
How often will I need to be seen in the Rosie Ante Natal Clinic (ANC)?
As we indicated at the start of this information, currently, we are trying to aim to keep face to face contact to a minimum.
You will need to come to the Rosie reception to pick up an information pack and blood glucose measurement machine. Details will be confirmed with you, when we ring to give you your diagnosis.
When you link your blood glucose machine to the App, it will allow us to view your results. Outside of routine appointments, we will only review your blood glucose results if you contact us via telephone or email.
Routine appointments will be held every 4 weeks with the diabetes in pregnancy team until 36 weeks. These will be telephone appointments, unless agreed otherwise. [Please note: they will appear as routine appointments on MyChart]
Fetal growth scans at 30 and 36 weeks. At these appointments you will have a blood pressure measurement and a urine test. A member of the obstetric team will ring you to discuss your scan results.
How do I contact a member of the Diabetes in Pregnancy team?
If you note 3 or more readings out of target within a week (these can be at any time of the day and do not need to be consecutive), contact us as follows:
Email (Preferred) - Please include your Full name, Hospital or NHS Number and Date of Birth in your email
Phone (Answerphone) - Rosie Midwives: Mon-Fri 01223 217 657
Please remember to clearly state your Full name, Hospital or NHS Number and Date of Birth and contact number in your message
Please remember: In the current situation, for your protection, we are working hard to reduce the need for face-to-face appointments. It very important that you stay in contact with us regularly and alert us if you are struggling to achieve your blood glucose targets. Without contact from you we will not be aware that you need help, causing delay in treatment and increase in risk to your pregnancy.
Labour, delivery and the post natal period in Gestational Diabetes
Remember: Most women with gestational diabetes have normal, healthy babies and the gestational diabetes disappears after delivery.
Consultant led care is recommended for a pregnancy associated with gestational diabetes with delivery on the Rosie hospital delivery unit. Timing and mode of delivery will depend upon many factors, to be discussed with you at your appointments.
After delivery, to check for resolution of gestational diabetes we will ask you to get a HbA1c blood test at your GP practice 3-6 months after delivery. We will send you a blood test form for this. [Please note this is line with latest guidance and may differ from the information leaflet below]
We encourage contraception till you are ready and can plan for your next pregnancy. You can ask for a depot contraception injection post delivery and before discharge.
The video below explains
Video: Gestational diabetes – how to manage in labour and after delivery (opens in a new tab)
If you are unable to view the video – Gestational diabetes – how to manage in labour and after delivery transcript.
- How to prepare yourself for labour and delivery
- How to prepare yourself for future pregnancies as gestational diabetes can return in subsequent pregnancies
- How to reduce your long term risk of type 2 diabetes as having gestational diabetes put you in a higher risk group.
Additional information can be found in this leaflet - Life and lifestyle information for after a pregnancy with Gestational Diabetes
How can I prepare for my baby?
Immediately after delivery, skin-to-skin contact is beneficial to you and baby. Please see the video for more information.
Video: The benefits of skin-to-skin (opens in a new tab)
If you are unable to view the video – The benefits of skin-to-skin transcript
You can consider harvesting colostrum after 36 weeks of gestation. This can provide additional nutrition for your baby if needed and may make it easier to breast feed after your baby is born. Please see the video for more information.
Video: Early expressing of breast milk (opens in a new tab)
If you are unable to view the video – Early expressing of breast milk transcript
What medications can be used to support gestational diabetes management?
For many of you following the diet and being active after meals will be enough to keep your glucose levels in the target range for pregnancy. However, if despite your best efforts with diet and activity, your blood glucose is still out of target, medication will be needed to supplement diet and activity measures.
It is important you do not over restrict your diet to try to keep your glucose levels in target. You should not be hungry and should not have ongoing weight loss.
See our advice sheet for treatment options in Gestational Diabetes.
Metformin
Your first prescription for Metformin will be posted to you from the Hospital Rowland’s Pharmacy. Thereafter, you must get repeat prescriptions via your GP. We will write to your GP requesting them to add this to your list of medications.
Metformin is best tolerated with food (Ideally take with the first mouthful of food or immediately after eating); a maximum of 1g twice daily can be taken. To reduce potential gastric symptoms, doses will be increased gradually as guided by your diabetes team.
Metformin has been given approval for use in pregnancy by NICE (National Institute for Clinical Excellence) and more recently by the Medicines and Healthcare Products Regulatory Agency and the Commission on Human Medicines.
It is known that metformin crosses the placenta but research has shown no safety concerns around the use of metformin in pregnancy.
Metformin can be used alone or to supplement the use of injected insulin during pregnancy if clinically indicated.
Insulin
If needed, we may ask you to start insulin injections to control your glucose levels on waking and /or after meals. This is not as scary as it sounds. In fact, these insulin injections are simpler than the finger stick glucose checks you are already doing successfully.
Insulin used to control waking glucose levels is long acting insulin, called Insulatard®, and is taken at bedtime.
Insulin used to control post meal glucose levels is quick acting insulin, called Novorapid®, and is taken before the relevant meal.
Your first prescription for insulin and needles will be posted to you from the Hospital Rowland’s Pharmacy. Thereafter, you must get repeat prescriptions via your GP. We will write to your GP requesting them to add this to your list of medications.
Watch this video demonstrating how to do an insulin injection using the different insulin pens.
Video: How to do an insulin injection (opens in a new tab)
If you are unable to view the video – How to do an insulin injection transcript
One of the only side effects of insulin treatment is low blood glucose or hypoglycaemia. This is rare in gestational diabetes but could occur if for any reason you took insulin but were unable to eat for example.
For this reason, always ensure there is a source of carbohydrate in your meals particularly if you are on quick acting insulin (such as Novorapid®).
Watch this video for information on hypoglycaemia and how to manage it
Video: Hypoglycaemia management (opens in a new tab)
If you are unable to view the video – Hypoglycaemia management transcript
- Hypoglycaemia leaflet
- Driving regulations
- Injection site selection
- Insulatard® user guide
- Novorapid® user guide
Repeat prescriptions
Ongoing supplies of blood glucose test strips, lancets and sharps box as well as Metformin and Insulin (if you are on these) will be as a repeat prescription from your GP.
We will have sent letters to your GP informing them to add these to your list of medications.
In the current extraordinary circumstances, GP practices are under immense pressure and it may take them or the pharmacy longer to dispense medication. Therefore, please put in a request for repeat prescription at least 4-7 days before you are due to run out.
Finally,
If you have any questions about the information above or any other concerns, please contact our team. We are here to support you and would like to reassure you that we will do all we can to help.