Managing diabetes in pregnancy

First Trimester (Conception to week 12)

• You should make sure you contact your general diabetes service to let them know, most maternity hospitals have a diabetes in pregnancy team, we recommend contacting them as soon as possible after your positive pregnancy test. It is never too early!
• You will be brought in to see the diabetes team for an early visit to help with your blood glucose control in pregnancy, you will be seen by obstetricians at around 7-8 weeks’ gestation
• You will need frequent contact with the diabetes team for blood glucose review and insulin adjustment.
• You will have frequent appointments in the early stages of pregnancy to try and ensure your blood glucose levels are stable to help the developing baby
• You will have an early pregnancy scan to date your pregnancy and confirm viability
• You will have retinal screening performed within the National Retinal Screening Pregnancy Pathway

• You will have regular scans to check baby’s growth and development
• Insulin may need to be increased often as pregnancy hormones increase
• Screening for pregnancy related complications (for example: preeclampsia)
• You will typically have an appointment in the hospital every 3-4 weeks in this trimester
• You will have a fetal anomaly scan and in some centres you will have fetal echo to check your baby’s heart structure and function.

• You will have visits every 1-2 weeks as you approach the end of your pregnancy
• You can often have more frequent growth scans to check on baby’s size and the amount of fluid (amniotic fluid) around the baby
• You will need frequent insulin adjustments and we will also make a plan for labour and delivery
• You will discuss breastfeeding and antenatal expression of colostrum is recommended to all women with diabetes in pregnancy.

Labour and Delivery

• You will have your baby in a maternity hospital and will be closely supported by a midwife
• Your baby’s heart rate will be monitored throughout labour and delivery
• You will have an intravenous drip, containing some insulin, to help keep your glucose levels stable
• The obstetric and midwifery teams will guide you through your choices for birth. These include vaginal delivery and caesarean section

Postnatal

• After delivery, your insulin requirements reduce very quickly, and your diabetes team will give you a postnatal dose to help manage this.
• Your blood glucose will be monitored closely by hospital staff
• Your baby will have their blood glucose checked also to check for low blood glucose.
• Breast feeding is encouraged, and you will be supported by your maternity centre on your breastfeeding journey

Contraception

• Discuss safe options early and if you plan for another pregnancy seek out your pre-conception clinic

Mental Health

• Be aware of mood changes, stress and diabetes related burnout
• Support is available – never hesitate to ask

Gestational diabetes is caused by hormonal changes during pregnancy that affect how your body uses insulin, the hormone that helps move glucose from your blood into your cells for energy.

• Pregnancy hormones may cause hyperglycaemia (high glucose levels)

During pregnancy, your body produces hormones that help your baby grow. The same hormones increase glyceamia and your body needs to produce more insulin. In GDM, your body becomes resistant to insulin and glucose regulation does not work properly, causing high glucose levels.

• Your body needs more insulin

To keep your blood glucose levels in a healthy range, your body needs to make 2 to 3 times more insulin than usual during pregnancy.

Who is more likely to get gestational diabetes? Risk factors for developing gestational diabetes include:

• Over 40 years old
• BMI >30kg/m2
• Previous gestational diabetes (in a previous pregnancy)
• Family history of diabetes
• Certain medical conditions (eg. PCOS)
• Long term steroid use
• Previous baby >4.5kgs
• Ethnicity with high prevalence of diabetes
• Suspected macrosomia
• Multiple pregnancy

How will I know if I have gestational diabetes?

Most people don’t feel any symptoms of gestational diabetes — which is why it’s important to be tested, even if you feel completely well.

The most common test used is called the Oral Glucose Tolerance Test, or OGTT. It’s usually done between 24 and 28 weeks of pregnancy, though it may be offered earlier if you have had gestational diabetes before.

How is gestational Diabetes treated?

Treatment for gestational diabetes focuses on keeping your glucose levels within specific target ranges, as advised by your diabetes team. You will be advised how best to achieve these by your care team, which may include the following:

• Nutrition and Lifestyle Modifications
• • All treatment options for gestational diabetes will include meeting a dietitian to learn how to balance meals, to manage glucose levels.
  • Balanced meals that include slow-release carbohydrates (like oats, wholegrain bread, and vegetables).
  • Regular eating times (avoiding long gaps without food).
  • Including protein and fibre to help steady glucose levels.
  • 30 minutes of moderate intensity activity, like walking, if it’s safe for you.
  • You’ll often meet with a dietitian or diabetes midwife to help build a plan that works for your lifestyle and culture.