What to expect if you are diagnosed with gestational diabetes

Experienced midwife Barbara Wear shares what to expect if you’re diagnosed with this common pregnancy condition.

When you first have your pregnancy confirmed, so many emotions and thoughts run through your mind. Will your baby be a boy or a girl, who will they look like, will they be born healthy and even beyond the immediate thoughts and dreams, planning your future life together.

Apart from genetic, chromosomal or metabolic disorders (which are rare), looking after your physical, emotional, cultural and spiritual wellbeing while pregnant will give your baby the optimal environment in which to thrive.

One of the most common unexpected conditions in pregnancy is Gestational Diabetes Mellitus (GDM). I'd like to explain how this condition can affect you and your baby, how to care for yourself during your pregnancy and what the hours and days after the birth might look like.

GDM is diabetes that is first confirmed in pregnancy. When you have your first antenatal blood test, one of the tests taken will be your HbA1c. This allows your lead maternity carer (LMC) to receive a result which shows your blood sugar levels over the last few weeks. If the reading is higher than the expected ranges, then GDM may be identified. Your LMC will receive this result and contact you to put in place a plan for the coming weeks of your pregnancy.

GDM is not caused by anything you have eaten or taken during your pregnancy. It is caused by hormones that you produce during your pregnancy, and these hormones alter how your body uses insulin.

Not having enough insulin results in high blood sugar levels. As your pregnancy progresses, your body needs 2-3 times more insulin to maintain normal blood sugar levels. That’s a big ask!

Hearing you have gestational diabetes can be challenging, but by following advice given throughout pregnancy and keeping it well-controlled, you have every chance of progressing to a normal labour and birth, and having a healthy baby.

Your LMC will give you a blood testing kit so you can start checking your blood sugar levels daily, as well as providing information about diabetes and how to manage it well.

Your LMC will contact the nearest maternity hospital to let them know you have diabetes, as they will be monitoring your blood sugar levels by contacting you every 1-2 weeks by email or phone. You will be asked to have a growth scan at around 28 weeks and again at 36 weeks. There will also be blood tests as your pregnancy progresses to check that the other organs of your body are managing your GDM well.

In order to continue your pregnancy with as little concern for you as possible, it is important to follow the advice of your LMC and diabetes team.

Managing your GDM by eating well, keeping physically active and monitoring your blood sugar levels, means you have every chance of your pregnancy continuing with minimal intervention.

This is called diet-controlled gestation diabetes and is the most common type of diabetes we see in the community. For these mamas, watching your diet and following the information given to you in pregnancy, your choices and outcomes should all be similar to the mama who does not have GDM.

However, for some, diet alone will not be enough to keep their blood sugar levels within a normal range. A team of diabetes specialists will start managing your care plan alongside your LMC. A tablet called metformin may be given and for those whose blood sugar levels are still high, insulin by injection may also be needed to stabilise it. 

At around 34 weeks your LMC will provide you information on colostrum harvesting/collecting. By having colostrum available for your baby after their birth, you might avoid the need for supplements should your baby have lower than normal range of blood sugar levels.  After the birth of your baby, your blood sugar levels should return to pre-pregnancy ranges. If your GDM was diet-controlled, no further testing will be needed until a three month visit to your GP where you will have a blood test to check your blood sugar levels. If you needed to use metformin or insulin, then you will need to check your levels for 24 hours after your baby’s birth. 

For baby, three normal blood sugar levels are required after their birth. Should any of these blood tests (requiring only one drop of blood, most commonly a heel prick) be lower than the expected range, then a feeding plan will be put in place and any colostrum you may have harvested will be given to your baby to bring their blood sugar level up. If you have no colostrum then a discussion around supplementary feeding will be had between you, your LMC, and maternity ward staff.

So, if you are diagnosed with gestational diabetes in pregnancy, talk to your LMC, talk to friends and family who will be supporting you through this unexpected outcome, read the information given to you by your diabetes team and ask lots of questions. You and your baby will be given the appropriate care required for a good outcome to your labour and birth, and the days following on from this very special day.

Barbara Wear is a midwife based in Canterbury with post graduate study in maternal mental health. With three grown children and nine grandchildren, life is busy but when there’s time, she loves reading, walking and interior design.