If you already have diabetes you should plan your pregnancy so you have good blood glucose levels prior to conception as this will reduce the risk of problems in pregnancy.

Your doctor should review any other medications you take and you should be taking folic acid 5mgs each day at least 12 weeks before you conceive as this also reduces the risks to your baby. We would like to see you in the diabetes in pregnancy clinic as soon as possible after a positive pregnancy test. The specialist team consists of diabetes consultants and specialist nurses, midwives and dieticians. You will be offered scans to check the development and growth of the baby and will need to be seen by the specialist team more frequently than women without diabetes.

Gestational diabetes

At the Rosie, all pregnant women are offered screening for gestational diabetes at around 28 weeks. Gestational diabetes (GDM) is a condition of pregnancy where the body is unable to process carbohydrate foods as well as it should and blood glucose levels rise above the normal levels. Normally, the amount of glucose in the blood is controlled by a hormone called insulin but for some women pregnancy hormones slow this response. In most cases, gestational diabetes develops in the third trimester (after 28 weeks) and usually disappears after the baby is born.

Once you have been screened and the test is positive you will be invited to attend the combined diabetes and pregnancy clinic where you will be taught how and when to monitor your blood glucose levels, and will be given advice on diet and lifestyle changes. Gestational diabetes can be controlled with diet and exercise. However, some women with gestational diabetes will need medication to control blood glucose levels. The diabetes care team will see you every one to four weeks to give help and support. This clinic runs on a Tuesday afternoon. You may also have a baby scan and an appointment with the obstetric team also on this day so please be prepared to be at the hospital for some time.

If gestational diabetes is not detected and controlled, it can increase the risk of birth complications, such as babies being large for their gestational age (macrosomia).

One of the major sources of food for your baby is the glucose in your blood. If your blood glucose levels run high your baby receives more food than it needs and it will grow larger than it should. This can increase the risk of complications during labour and will influence how your baby is delivered. 

The growth of your baby will be monitored closely by scans. Keeping your blood glucose levels under tight control will help prevent accelerated growth in your baby.

Neonatal hypoglycaemia 

If your baby is exposed to high blood glucose levels, particularly at the end of your pregnancy, it increases the risk of the baby’s blood glucose levels dropping too low afterwards. This is known as 'hypoglycaemia'. It can take a few days for the glucose levels to stabilize again. So your baby’s blood glucose levels will be checked by a small heel prick test four hours after delivery and then with the next few feeds, to be sure that they stay in the normal range. Your baby may need either expressed breast milk or a formula feed to maintain their blood glucose levels, the midwives and support workers will help you with this.

Type 2 diabetes in later life

It is unlikely that the diabetes will remain after your baby has been born and most women’s blood glucose levels return to normal within a day or so. You should have a repeat glucose tolerance test (GTT) six weeks after the birth to confirm this. If the result is normal we will write to inform you of this. If the result has remained high we will invite you back to the antenatal clinic to discuss the result.

After your baby is born you will probably stop blood glucose monitoring (though some mother’s are asked to continue) and return to a normal healthy diet.

Research studies show that women who developed gestational diabetes have a 50-70% chance of developing Type 2 diabetes later in life.

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