Diabetes and Pregnancy: Gestational Diabetes

This leaflet aims to explain what gestational diabetes (GDM) is, what this means for you and your pregnancy, how you can manage it and outline the care you will receive before and after your baby is born. Please discuss any aspect of your care with us during your clinic appointments or contact us with any questions.

The team that will look after you is made up of the obstetrician (doctor specialising in pregnancy), physician (doctor specialising in diabetes), diabetes specialist midwife, diabetes specialist nurse and diabetes specialist dietitian.

What is gestational diabetes?

Gestational diabetes is a condition that can occur in pregnancy when the body becomes less able to regulate the levels of sugar, called glucose, in the blood. As a result, the glucose levels can rise above normal levels. This is important as the higher blood glucose levels cross the placenta to your baby and can affect the outcome of your pregnancy.

It typically occurs during the second half of pregnancy although it can occur earlier and usually disappears after your baby is born. (a blood test is taken to confirm this 3 months after birth).

Normally, the hormone insulin regulates blood glucose levels within the normal range of 3.5mmol/L to 7.8mmol/L.

During pregnancy, the body becomes resistant to the action of insulin, so it needs to produce more insulin to maintain blood glucose levels within the normal range.

Gestational diabetes occurs when the body is unable to produce enough insulin to meet the extra needs of the pregnancy.

Why do I have gestational diabetes?

Please be assured you have not caused this diagnosis for example by eating sugary foods in this pregnancy.

You were screened based on certain risk factors for developing gestational diabetes that are listed below. The outcome of these tests is reflective of these risk factors and other pregnancy-related factors, many of which are can’t be modified.

Who is at risk of gestational diabetes?

Gestational diabetes can develop in any pregnancy. Sometimes there is no obvious reason for it. Sometimes it is related to a recognised risk factor which can include:

• having had gestational diabetes in a previous pregnancy
• having a strong family history for diabetes
• being overweight – body mass index (BMI) above 30kg/m2 at booking
• some ethnic backgrounds -South Asian, Chinese, Black African, Afro-Caribbean, Middle Eastern.
• taking certain medicines

You will be offered screening for gestational diabetes if you have one or more risk factors.

How will gestational diabetes affect my pregnancy and birth?

Some things will happen differently for your pregnancy now that you have gestational diabetes.

• You will be seen in the diabetes antenatal clinic. The diabetes team will usually review you every one to four weeks to assess your blood glucose readings and the obstetric team will see you after your scans. See section Clinic visits for more detail.
• You will need to be incredibly careful with your diet throughout the rest of your pregnancy and during the birth of your baby. We cannot overemphasize how important diet and activity are in managing gestational diabetes. Please take extra care reading the Dietary section and try to incorporate as much of the guidance as possible to help keep your blood glucose levels in a healthy range for your baby.
• We encourage you to keep active every day. See section on Activity advice.
• You will need to monitor your blood glucose levels four times a day for the rest of your pregnancy. This is the only way you can see that your glucose are in a healthy range and this can change with each week of your pregnancy. See section on blood glucose monitoring.
• We will offer you extra scans to monitor the growth of your baby at 28, 32 and 36 weeks.

If you have diet-controlled gestational diabetes and your growth scans have not suggested any concerns with your baby, then you can choose to give birth in the Rosie Birth Centre where you will be offered low-risk labour care. Your obstetrician will discuss your birth options with you at 36 weeks. You will also be offered induction of labour at 41 weeks – this is known as “post-dates induction”.

• If you require medication and/or if there have been any concerns regarding you or your baby’s wellbeing, such as restricted growth on a scan then it is recommended that you give birth on the Delivery Unit where you will be offered continuous electronic foetal monitoring, hourly blood glucose monitoring and additional care, if required. You will be offered induction of labour before 41 weeks. This will be dependent on your individual needs and will be discussed with you by your obstetric consultant.

You will have appointments at 32 and 36 weeks to discuss your birth plan and choices. After the birth of your baby, we recommend that you remain in hospital for around 24 hours so that yours and your baby’s glucose readings can be monitored. If you have given birth on the Rosie Birth Centre, this will mean that you will need to transfer to Lady Mary ward for your postnatal care.

What does having gestational diabetes mean for my baby?

Most pregnancies with gestational diabetes end in a healthy baby born close to term. However, having gestational diabetes increases the risk of some complications. The two main ones are explained below.

We can discuss this with you further during your clinic appointments.

Macrosomia – when the baby is affected by accelerated growth

One of the major sources of food for your baby is the glucose in your blood. If your glucose readings run above the healthy pregnancy targets, the glucose passes directly to your baby. This causes your baby to produce more insulin and can make your baby grow larger with excess fat stores in unhelpful places such as the waist and shoulders and unhealthy places such as the liver. These excess fat stores have been found to increase the risk of obesity and type 2 diabetes in your child’s future health.

Having a big baby increases the risk of complications during the birth such as shoulder dystocia (when one or both of your baby’s shoulders get stuck during labour) and can influence when and how your baby is born. The growth of your baby will be monitored closely by extra scans, and we will discuss your birth choices with you towards the end of your pregnancy.

Keeping your blood glucose readings within the healthy range for pregnancy helps reduce these risks.

Neonatal hypoglycaemia – when the baby’s blood glucose levels fall too low after birth

If your glucose readings are regularly above the healthy range for pregnancy, the extra glucose passes to your baby and causes your baby to produce more insulin than normal.

If this happens towards the end of pregnancy, the baby’s glucose levels can fall too low after birth as your baby continues to produce more insulin. Your baby may require extra support to maintain their own glucose levels in the first few days after birth.

To reduce the risk of this happening, keep your blood glucose levels within the healthy range for pregnancy up to and during labour. Once your baby is born, skin-to-skin contact as soon as possible after birth and encouraging your baby to feed within the first hour will help stabilise your baby’s glucose levels. Your baby’s blood glucose levels will be checked within four hours of birth and then before the next few feeds which might mean staying in hospital for around 24 hours. We encourage responsive feeding for your baby.

Keeping your blood glucose levels in the healthy range for pregnancy allows your baby to grow at a healthy rate and keeps your baby’s blood glucose levels stable after birth.

Clinic visits

The diabetes in pregnancy team will review you every one to four weeks until 32-36 weeks gestation based on your individual circumstances, to give help and support.

If you have a scan on a Tuesday afternoon (after 12.30pm), you will be seen in clinic 21 (Antenatal Clinic) after your scan. Please always attend your scan appointment before coming to clinic 21 for your other appointments.

If you have a scan on a Tuesday morning (before 12.30pm) or at any other time or day of the week, you are likely to receive a phone appointment to speak with the team rather than asking you to come in on another day.

If you are booked for a face-to-face appointment on a Monday, please sign in at clinic 21 and then go up one floor to clinic 22 to be seen. If you have a scan on a Monday, please always attend that first before your clinic appointment regardless of the time that the clinic appointment is booked.

You will also be invited to two virtual group meetings (you will receive a letter with details):

• Soon after diagnosis – usually on a Wednesday – to discuss your diagnosis and how to manage it
• Around 35 weeks of pregnancy – usually on a Thursday – to discuss care specific to gestational diabetes around labour, the birth of your baby and post-partum care

Dietary advice

Diet and physical activity are the first, and often the only, form of treatment required for gestational diabetes. Your blood glucose readings can often be maintained within the healthy range for pregnancy by eating the recommended dietary choices and by being physically active after each meal.

You will need to follow the dietary guidance for the rest of your pregnancy and during the birth of your baby.

Carbohydrate foods

Carbohydrate foods directly affect blood glucose levels and so are the focus of the dietary treatment.

When carbohydrate foods are eaten, they are digested and absorbed into the blood stream as glucose, causing the blood glucose levels to rise. The body then produces just the right amount of insulin to cover this rise. This prevents the glucose levels rising above the healthy range for pregnancy.

With gestational diabetes, the body is unable to produce enough insulin, or the insulin that is produced is less efficient, and therefore your blood glucose readings can rise above the healthy range for pregnancy.

To overcome this and keep your blood glucose readings in the healthy range for pregnancy it is helpful to avoid refined (highly processed) carbohydrates and to consider the amount of carbohydrate that you eat at a time, often meaning having smaller portions more frequently. Avoid skipping meals.

However, it is important to continue to include carbohydrates in your diet since a healthy balanced diet should contain some carbohydrate food with each meal and snack to provide energy, fibre, vitamins, and minerals.

It important to eat enough carbohydrate for a healthy diet but not too much to overload your insulin production.

Carbohydrate foods include potato, bread, rice, pasta, yam, cassava, noodles, couscous, breakfast cereals, crispbread, foods containing flour (cakes, biscuits, pastry, pizza), fruit, milk, yoghurt, sweets, chocolate and sugar.

You will need to avoid some of these foods completely and be careful about how much you eat of others.

The table below lists the foods to avoid and suitable alternatives.

Carbohydrate portions

The larger the portion of carbohydrate foods eaten, the higher the glucose levels rise and the more insulin the body needs to cover it. When you have gestational diabetes, the body is not able to produce large amounts of insulin at any one time, so will not be able to cover large portions of carbohydrate foods.

An important part of the dietary guidance is to eat smaller amounts of carbohydrate and spread it out over the day.

You may be asked to eat smaller meals and have additional snacks in between meals so that you eat the same amount over the day but in smaller, more frequent quantities. See section on suitable snacks.

Avoid doubling up on carbohydrate foods in one meal, for example do not have bread and potatoes or bread and pasta together.

It is important that some carbohydrates are included at each meal. They should not be avoided or overly limited to keep blood glucose readings down. Including carbohydrate at meals and snacks helps to avoid hunger, meet your body’s nutritional and energy needs and encourage healthy weight gain over the pregnancy.

We encourage that you eat to hunger.

It is common to lose a little weight in the first few weeks after following these recommendations. However, we will monitor that this weight loss is not ongoing.

There will be an opportunity to be reviewed by a dietitian.

Carbohydrate type

The following table lists the foods identified as being best avoided and gives suitable alternatives.

Processed carbohydrates have a high glycaemic index (GI) and cause a faster rise in blood glucose readings.This makes it harder to keep the 1-hour post-meal glucose readings within the normal range so they are best avoided.

High fibre, unrefined/unprocessed carbohydrates (low GI) create a slower rise in glucose making them a better choice.

Breakfast

Carbohydrate is often less well tolerated at breakfast. You may need to split what you would normally eat over breakfast and a mid-morning snack; for example, 2 slices of toast would become 1 slice of toast at breakfast and 1 slice of toast mid-morning.

Breakfast ideas choices:

1 slice wholemeal toast with a topping e.g.. poached eggs/ scrambled eggs/mushrooms/tomato/avocado/cheese/ham/other cold meats.

Or: 1 small pot yoghurt (less than 15g total carbohydrate per pot) with one portion of chopped fruit or a cup of berries (optional: can top with nuts or seeds)

Or: 25g jumbo porridge oats mixed with crème fraiche and 1 cup of berries (frozen berries work especially well if all left together in the fridge overnight) optional – top with nuts or seeds.

Or: 40g jumbo porridge oats made into porridge with water and single cream added to taste (may be flavoured with mixed spice, cinnamon or artificial sweetener).

This can then be repeated mid-morning or choose a snack from the list below.

Carbohydrate portion for lunch and evening meal

Please include carbohydrate at each of your meals. The quantity you will tolerate may vary but the following portions are a good place to start; aiming for 40g carbohydrate at lunch and evening meal.

Bread: 2 medium slices/1 dessert plate sized chapatti or wrap/1 medium roll/1 medium pitta bread

Cooked rice/pasta/couscous: 4 heaped tablespoons

Potatoes: 4 egg sized, 3-4 tablespoons mash, 1 small jacket potato.

See menu suggestions below.

Timing of Evening Meal

• Please eat your evening meal before 7.30pm.
• Research and experience show that the later the evening meal the more this impacts the glucose overnight and can cause the level to be higher than healthy. High glucose levels overnight are more likely to cause unhealthy weight gain in your baby.
• Some can find this a struggle and options to help are:
• Have your main meal at lunch time and have your snack meal in the evening which is quicker to prepare
• Do some batch cooking so you have some prepared meals that just need reheating

The following foods and drinks have minor impact on blood glucose levels and can be enjoyed in your usual amounts.

Protein foods such as meat, fish, eggs, cheese, tofu, Quorn, peas, beans, and lentils have little, if any, effect on glucose levels and can be eaten freely.

Non-starchy vegetables and salad vegetables have little, if any, effect on glucose levels and can be eaten freely.

Eating more protein and non-starchy vegetables or salad with your meals can help stop or reduce hunger. Always eating protein foods and/or non-starchy vegetables or salad vegetables with carbohydrates can make the post meal glucose easier to manage and keep post meal blood glucose readings in the target range.

Carbohydrate-free drinks include tea and coffee with a splash of milk, Bovril and oxo. However, latte and flat white coffees contain carbohydrate due to their higher milk content and should be kept to between meals rather than with meals.

You can add flavour and interest to food and meals by using herbs/spices/oils/vinegars or mustard as these have no impact on glucose levels.

Foods labelled as 'Diabetic Foods' are not recommended as part of your diet due to their contents.

Hints and tips for extra snack ideas

Carbohydrate free snacks (have little or no impact on blood glucose) can be enjoyed at any time of day:

• Antipasti – sun blushed tomatoes, roasted vegetables (such as peppers and courgettes)
• Olives
• Avocado
• Pickled onions or gherkins
• Cheese cubes (ensure pasteurised and avoid mould-ripened soft cheese)
• Quorn slices
• Cocktail sausages
• Salad (thoroughly washed)
• Cold meats (avoid all pâté, deli meats and ensure well cooked)
• Seeds
• Cooked fish such as sliced salmon, mackerel, prawns, and seafood sticks
• Small corn on the cob
• Eggs (avoid undercooked or raw eggs without the Lion Code)
• Sugar free jelly
• Grilled asparagus wrapped in cooked ham
• Sugar-free lollies (homemade or bought)
• Grilled mushrooms with cheese (or other spreads or dips inside)
• Tofu (without the sugar rich marinates such as Hoisin)
• Lettuce roll-ups with cooked meat, bacon, egg, tuna, cream cheese, or another filling
• Tomatoes (cherry, plum or salad tomatoes)
• Nuts (unless otherwise advised)
• Tuna and sweetcorn with shop-bought mayonnaise (limit tuna to 4 medium-sized cans per week)

Snacks containing carbohydrates

These are best eaten 1.5-2 hours after breakfast and 1.5-2 hours after lunch.

• A cup of berries with or without a spoon of crème fraiche (when made with frozen fruit can be an enjoyable substitute for ice cream)
• 3-4 plums
• 1 small apple
• 2 oat cakes
• 1 small banana (fun size/kid size)
• 2 whole-wheat crackers
• 1-2 clementines
• 1 slice of wholemeal bread
• 10-12 grapes
• 1-2 plain digestive biscuits
• 1 peach
• 1-2 plain Hobnobs®
• 1 nectarine
• No added sugar Angel Delight®
• 1 pear
• 1 small glass of pasteurised milk
• 1 orange
• 1 small glass of oat milk
• 1 kiwi
• 1 yoghurt (14g of less total carbohydrate)
• 70% dark chocolate - 1 larger square or 3 smaller squares
• Small bag of crisps (Kettle or Walker best as cut from the potatoes)

Drink ideas

• Diet soft drinks (be aware that cola contains caffeine, and it recommended to limit intake of caffeine in pregnancy)
• Sugar-free squash
• Unsweetened soya milk
• Unsweetened coconut milk
• Unsweetened almond milk
• Unsweetened pea milk
• Cadbury’s Highlights®
• Cocoa powder

Please continue to avoid foods not recommended in pregnancy, visit NHS - foods to avoid in pregnancy (opens in a new tab) for further information or ask anyone from the pregnancy in diabetes team.

Suggested menus

Split breakfast

• 7-8am: small pot yoghurt with cup of berries sprinkled with seeds.
• 9-10am: 1 x medium slice of wholemeal toast with protein topping (cheese/ ham/ egg/ peanut butter).

Mid-day meal

• 2 x medium slices wholemeal bread sandwich with protein filling.
• Or soup and wholemeal roll.
• Or as for evening meal.
• 1.5 - 2 hours later: piece of fruit or a yoghurt.

Evening meal

• 4 x egg sized potatoes or 4 x tablespoon cooked rice, pasta, or grains with generous portion of protein and plenty of vegetables or salad.
• 1.5 - 2 hours later: a carbohydrate free snack such as vegetable sticks with houmous or cream cheese.

Snacks

• Two carbohydrate-containing snacks are suggested across the day between meals.
• Carbohydrate-free snacks can be eaten at any time and are an excellent choice in the evening if hungry

Physical activity

You are recommended to be active for 10-15 minutes straight after each meal and large snacks.

• Regular physical activity will improve your body’s sensitivity to insulin and makes it work more effectively, especially if this is straight after meals.
• This is just as important as the dietary changes and can make up to 2mmol/L difference to your post-meal glucose reading.
• Helpful types of activity include walking, swimming, cycling, being active around the house, dancing, moving legs and/or arms whilst sitting on a chair.
• Structure your day to make space for post-meal activity. This may mean eating a meal a little earlier or getting the support of family and friends to free your time to be active.
• If you are struggling with increasing activity, please discuss this with us during your clinic appointment.

Weight gain

Being overweight or gaining too much weight in pregnancy can add to the risk of complications associated with gestational diabetes.

If you were overweight at the start of your pregnancy keeping your weight stable for the rest of your pregnancy can help reduce these risks and make it easier to keep your blood glucose levels in the healthy range for pregnancy with diet and activity alone.

You may find that following the diet and lifestyle recommendations for gestational diabetes prevents any further weight gain.

Eating more protein foods and healthy snacks can help manage hunger.

If you are concerned about your weight, please discuss this with us during your clinic appointment.

Sleep

Please let us know if you are struggling to sleep at night as this can affect your blood glucose readings overnight and first thing in the morning.

Blood glucose monitoring - Blood glucose meter

Please watch this video demonstrating how to use the blood glucose meter: How to use the Accu-Chek Instant meter (opens in a new tab). Written instructions are available in the meter box to guide you.

• You will be able to share your glucose levels with the diabetes team by setting up the Glooko App on your phone. Instructions are included with the meter and in Appendix 1.
• Ongoing supplies of blood glucose test strips and lancets will be as a repeat prescription from your GP.

You will be asked to monitor your blood glucose levels four times every day:

• Fasting (before eating or drinking anything) and ideally within 5 to 10 minutes of waking.
• One hour after breakfast, lunch, and dinner (timed from start of meal).

It is important that you always wash your hands before checking your blood glucose levels to avoid getting false high readings. Wash your hands with soap (without moisturiser or glycerin) and water and avoid alcohol gels and wipes as these can affect the reading.

The blood glucose levels you are aiming for are listed below.

If you get a reading above target range, please write down what and how much you ate at the meal before or if you were inactive or feeling unwell.

If you get three readings above these targets within 1 week, please contact the diabetes in pregnancy team (see contact details below).

If you are seeing glucose levels above the recommended targets, some things to consider are:

Fasting: if your glucose levels are occasionally above 5.3 mmol/L consider the potential causes below:

• Timing of evening meal - aim for this to be before 7.30pm
• Snacks in evening/overnight - please ensure snacks and drinks (including antacids) are carbohydrate free - see carbohydrate free snacks above
• Timing of glucose measurement - ensure this is within 15 minutes of waking AND you have washed your hands
• Have you had a poor night’s sleep? This can increase insulin resistance and therefore cause higher fasting glucose levels

1 hour after meals: if your glucose levels are occasionally above 7.8 mmol/L and scattered over all meals consider the potential causes below:

• Carbohydrate type - was it low fibre or more processed than usual? - see carbohydrate table above to make best choices
• Carbohydrate quantity - was it more than usual? - see portion guidance above
• Post meal activity - was this missed or less than usual?
• Have you had a carbohydrate-containing snack or drink between finishing your meal and doing the glucose measurement?
• Please ensure you are washing your hands. If away from home use plain water and a tissue to clean the finger

If more than half your readings are above target at the same time of day over a week; please discuss this with us at your next clinic appointment, if in the next 7 days. This means if 4 or more out of 7 readings fasting or after the same meal. If your next clinic appointment is longer than 1 week away, please get in touch – see contact details below.

Will I need to have medication?

• Not necessarily; many are able to regulate their blood glucose levels by following the diet and physical activity recommendations above.
• However, some do not produce enough insulin to cover what they need to eat to support a healthy pregnancy and, despite their best efforts, need to start some medication to keep blood glucose readings in the normal range. It is important to remember that needing medication to help your blood glucose readings does not mean that you have failed in any way.

There are two options for medication:

Metformin is a tablet that enables the insulin you produce to work more effectively.

• Metformin is endorsed by the National Institute for Health and Care Excellence (NICE) for use in pregnancy. There have been several good studies to show it can be used safely in pregnancy and it has been used for many years in clinical practice. We need to inform you though that, for regulatory reasons t, metformin does not carry a UK license for use in pregnancy.
• Metformin is a medication that crosses the placenta. Iff you feel strongly about this and want to avoid using metformin, the only alternative medication is insulin. Please discuss this with us so we can make the right choice for you.
• Metformin is best tolerated with food (Ideally take with the first mouthful of food or immediately after eating). To reduce potential gastric symptoms, doses will be increased gradually as guided by your diabetes team up to a maximum dose of 1g twice daily.
• More information on metformin and how to take it is available on our treatment options page.

Insulin injections to 'top up' the limited amount of insulin your body can produce. This may be before bed and/or before meals.

Which is the best choice for you will be discussed with you during your clinic appointment.

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.

More information on insulin treatment is available on our treatment options page.

• Insulin used to control waking glucose levels is long-acting insulin, most commonly Humulin I®, and is taken at bedtime.
• Insulin used to control post meal glucose levels is quick acting insulin, most commonly Trurapi®, and is taken before the relevant meal.
• Watch How to do an insulin injection (opens in a new tab)
• Written information is available on links below
  • Trurapi® injection (opens in a new tab)
  • Humulin I® injection (opens in a new tab)

Medication supplies

Your first supply of medication may be issued from the hospital out-patient pharmacy or from your GP. Ongoing supplies will be from your GP.

Hypoglycaemia

• 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 Trurapi®).
• Please watch or read the following:
  • Watch this video for information on hypoglycaemia and how to manage it (opens in a new tab)
  • Written information on Hypoglycaemia leaflet (opens in a new tab)
  • Insulin and Driving regulations (opens in a new tab)

Obstetric care

You will be offered additional growth ultrasound scans to monitor your baby at 28, 32, 36 and 40 weeks (or the next available opportunity if already over 28 weeks). You will also have an appointment with the obstetric team to discuss the result of the scan. You will also be allocated a consultant obstetrician, if you do not already have one, to help plan your care for the remainder of your pregnancy.

It is important to continue to see your community midwife throughout your pregnancy for routine antenatal care.

Baby’s movements: please monitor your baby’s movements carefully and contact the maternity assessment line 01223 217217 the same day if you note any change or reduction in movements. This number is open 24/7.

Labour, birth, and the post-natal period with gestational diabetes

Remember: Most pregnancies with gestational diabetes end in normal, healthy babies and the gestational diabetes disappears after the birth. After birth, please stop all diabetes medication unless advised otherwise.

You will be invited to a virtual group meeting at around 35 weeks to give information about labour, birth, and post-natal period. It is recommended that you attend this.

For some who have been diagnosed with gestational diabetes, it is recommended by NICE for you to give birth to your baby on the Delivery Unit as this allows for close monitoring of you and your baby and additional medical support is available if required.

• You will have the opportunity to discuss your birth plan with the obstetric team and the specialist midwife between 32 and 36 weeks.
• When and how you give birth is influenced by several things: your choice, how your gestational diabetes has been managed and the growth of your baby.
• If you have diet-controlled gestational diabetes and your growth scans have not suggested any concerns with your baby, then you can choose to give birth in the Rosie Birth Centre where you will be offered low-risk labour care (or receive the same care on the consultant-led Delivery Unit if this is your preference).
• If you require medication and / or if there have been any concerns regarding yours or your baby’s wellbeing, such as restricted growth on a scan, it is recommended that your give birth on the Delivery Unit where you will be offered continuous electronic foetal monitoring, hourly blood sugar monitoring and additional care if required.
• If you wish to have a planned caesarean birth you can also discuss and plan for this with your consultant.
• NICE guidelines recommend that if you have gestational diabetes, you would give birth by 40 weeks and 6 days although in some circumstances, earlier birth would be recommended; for example, if your baby is larger, there is increased fluid, or you require insulin. If you do not go into spontaneous labour before your recommended birth time, we will discuss the options for birth with you and provide you with the additional information.

Diet during birth

If you are eating during labour, it is important that you keep to the diet you have been following to keep your blood glucose readings within target.

The hospital menu might not be able to support your dietary choices, and you may wish to bring some of your own snacks, foods, and drinks in with you that you feel will be able to maintain blood glucose readings within the target range. An information leaflet will be provided to you before your hospital admission to help you plan what foods and drinks to pack in your hospital bag.

Blood glucose monitoring

Continue to check your blood glucose levels during labour and for the first 24 hours after birth. Once your baby has been born, the targets for your blood glucose readings change as below.

If you get readings above these levels, please inform a midwife on the ward.

Infant feeding

Breastfeeding is encouraged as a good option for both you and your baby. If you plan to breastfeed and would like information on antenatal colostrum collection, please mention this at your 36-week appointment. There is also further information available on our website: CUH - Antenatal hand expression.

Skin-to-skin contact is recommended for you and your baby, please watch 'The benefits of skin-to-skin' video (opens in a new tab) for more information.

What does having gestational diabetes mean for me in the future?

• Gestational diabetes usually goes away once your baby is born. This will be checked with a blood test three months after the birth of your baby at your GP surgery or at the Rosie Hospital (please come to Clinic 21 in the Rosie hospital Monday to Friday 08:30 - 16:00. No appointment is needed); please ensure that you attend for this test. If you choose to have your blood test at the Rosie Hospital and the result is normal, we will write to inform you of this. If the result has remained high, we will invite you back to clinic to discuss the result. If you decide to have your blood test with your GP, please ensure you follow this up to discuss the result.

Please book a glucose blood test with your GP surgery once a year to screen for type 2 diabetes. A good time to remember to do this is in the same month that your baby was born.

Having had gestational diabetes means you are likely to develop gestational diabetes in any future pregnancy and more likely to develop type 2 diabetes in the future.

Reducing your risk of developing type 2 diabetes

Research studies show that following a pregnancy with gestational diabetes there is a 50-70% chance of developing type 2 diabetes in the future.

There are several things you can do to reduce or delay your risk for developing type 2 diabetes.

• Maintaining a healthy weight will significantly reduce your risk of developing type 2 diabetes. If you are overweight, reducing your weight to within a healthy range after your baby is born will help reduce your risk of developing type 2 diabetes. However, do not start a strict weight reducing diet during the pregnancy or whilst breastfeeding. You can ask your GP to refer you to a dietitian or weight reducing programme if you would find this helpful.
• Attend the National Diabetes Prevention programme: This has been shown to be highly effective at reducing your risk for diabetes. You will be busy with your baby for a while but once you feel you have some time, we encourage you to attend this programme.
• Physical activity makes insulin work more effectively. Including some physical activity into your daily routine for 30 minutes will reduce the risk of developing diabetes. This needs to be additional to your normal daily activity and at a level that makes you breathe harder than normal; for example, a 30-minute brisk walk. This can be divided into smaller time slots if that fits into your routine better.
• Eating a healthy diet that is high in fibre, low in refined (highly processed) carbohydrate and low in saturated fat will help keep your weight in a healthy range. It also reduces the risk of developing type 2 diabetes.
• Research shows that breastfeeding reduces and delays the risk of developing type 2 diabetes following gestational diabetes.

Additional information can be found in this leaflet: Diabetes and pregnancy: diet and lifestyle information following a pregnancy with gestational diabetes (opens in a new tab).

Future pregnancies

• Due to the increased chance of developing gestational diabetes in subsequent pregnancies, mention this to your community midwife so they can arrange appropriate screening tests.
• If you are overweight during your current pregnancy, commencing a healthy diet and losing weight before your next pregnancy will reduce your risk of developing gestational diabetes.

Diabetes in pregnancy team contact details

The email and telephone are answered Monday to Friday 9am - 5pm.

• Email the diabetes in pregnancy midwifery team
• Diabetes specialist midwife: 01223 586901 (answerphone)
• Diabetes specialist nurse: 01223 348790 (answerphone)
• Diabetes specialist dietitian: 01223 349471 (answerphone)
• Appointments: 01223 217664

Urgent queries

Please call the Maternity Assessment Line in Clinic 23 on 01223 217217, the same day, with any concerns about baby's movements or any other pregnancy concern. They are open 24 hours/day.