Gestational Diabetes 

Gestational Diabetes is diabetes that develops during pregnancy. It happens because your body cannot produce enough insulin to meet the extra needs of pregnancy which results in high blood sugar levels. This usually occurs in the middle or towards the end of pregnancy.

If you are diagnosed with Gestational Diabetes during your pregnancy, you will be invited to an appointment to the Joint Antenatal Diabetes clinic. This will give you an opportunity for you to ask any questions you might have and gain an understanding of the care you can expect to receive from now and throughout your pregnancy.

At your first appointment you will see the Consultant for Diabetes, he will review your blood glucose levels and make a plan of care which may involve prescribing you some medication which he will discuss at the time. The plan is to maintain your blood glucose within the recommended target range for a healthy pregnancy. He will arrange to see you again and you can expect this to be anything from between 1-3 weeks.

During subsequent appointments you may see the Consultant or one of the Diabetes Specialist Nurses instead. It is the Nurse’s that you may need to contact regarding your blood glucose levels in between appointments and the number is on the top of your sheet where you record your blood glucose. Part of your care may be to see the Diabetes Dieticians who are always available in the clinic, however, you can request to see them yourself at any time.

Next you will meet the Obstetric Consultant or one of the Senior Registrars. You will be asked about your diabetes and any treatment you are taking. If you have had an ultrasound scan this will be reviewed and a plan for your pregnancy moving forward will be discussed and agreed with you. Your next appointment will be arranged and this will compliment your diabetes care plan.

The Specialist Midwives for Diabetes are available to offer any midwifery aspects of care and are there to coordinate the service and ensure that you receive the best possible care throughout your pregnancy. The good news is, that by managing your gestational diabetes, there is no reason why you won’t go on to have a healthy pregnancy and birth. The multidisciplinary care team are here to help and support you along the way.

After your baby is born:

Unless told otherwise from the diabetes team during your pregnancy, once the placenta is delivered you can stop your diabetes medication and stop blood glucose monitoring.

Your babies’ glucose levels will also be monitored for the first 24 hours to detect low blood glucose levels, early feeding skin to skin and breastfeeding can help with this.

Expressed Colostrum – Any expressed colostrum that you collected whilst you were pregnant can be given to baby as soon as they are born. This will help them to maintain their blood glucose levels and prevent hypoglycaemia.

Gestational Diabetes treated with insulin

If you have been treated with insulin during your pregnancy then it is advisable to monitor your blood glucose levels 2 hourly until your first meal and then monitor them pre meals for 24 hours after the birth.  If your pre-meal blood sugar levels are 7 or above you should inform the midwives on the ward.

Follow up in three months with your GP

Please make an appointment at your GP practice 13 weeks after the birth in order to have your blood glucose levels repeated, this is a simple blood test that can be performed any time of the day, and will test to see if your glucose levels have gone back to normal following your pregnancy.

If the test is normal it is still advisable to have this test done yearly in order to assess if you are developing Type 2 diabetes, as having gestational diabetes increases your risk of this.

It is also advisable to continue to have a well-balanced healthy diet and exercise to help reduce this risk.

Gestational Diabetes and Type 2 diabetes link

Having gestational diabetes increases your risk of developing it again in future pregnancies. It also increases your risk of developing type 2 diabetes after giving birth. And it also increase the risk of your child becoming overweight and going on to develop type 2 diabetes as an adult. But there are lots of things you can do to reduce your risk of developing type 2 diabetes including breastfeeding your baby, including having a well-balanced healthy diet and taking regular exercise.

More information is available on the Diabetes UK website here: https://www.diabetes.org.uk/preventing-type-2-diabetes

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Type 1 and Type 2 (pre-existing diabetes)

If you have pre-existing diabetes and are planning a pregnancy, there is lots of advice available on the Diabetes UK website here.

There is also lots of help available through our specialist diabetes antenatal team here at DBTH. We know having diabetes can be a worrying time when you are pregnant, but we are here throughout your pregnancy to help manage your diabetes during your journey with us.

The Diabetes team consist of multidisciplinary professionals that care for you throughout your pregnancy in a variety of ways and these include: Consultant Obstetricians (pregnancy doctors) Consultant Diabetologists, Diabetes specialist nurses, dietitians and midwives. They are here to help keep optimal control of your diabetes during your pregnancy as this will help reduce the complications that may arise if your diabetes is not well controlled.

What to expect during your pregnancy:

Your first diabetes antenatal appointment will usually be with the Consultant for diabetes and the Diabetes Specialist Midwives/Dietitians, this appointment can include:

• Taking a history of your diabetes
• Review of your diabetes treatments and medications; including your method of testing your blood glucose
• Discuss your current meter and ensure you have enough needles and strips, that they are in date and that you have ketone meter strips
• Offer of free continuous glucose monitoring will be discussed for a period of 12 months (Dexcom G6)
• Baseline diabetes and pregnancy bloods including a HbA1c and kidney function
• A referral to the eye screening department for regular checks throughout your pregnancy
• A review by the dietitian
• Leaflets and discussions on:
  • Sick day rules
  • Hypoglycaemia – ensuring you have treatments on you at all times
  • Driving rules
  • National Pregnancy in Diabetes audit

Please bring your glucose meter, records of blood sugar monitoring with you to each antenatal visit as this is vitally important for advice on diabetes control. If you are using a flash or continuous glucose monitoring system then this will be reviewed at these appointments as well.

Regular ultrasound scans will be offered throughout your pregnancy which include:

• 7- 9 weeks early viability scan
• 12 week dating scan – with offer of screening for chromosome abnormalities
• 20 week anatomy scan
• 3 – 4 weekly growth scans from 28 weeks until delivery

We will offer you regular diabetes review from your first appointment which can be face to face or telephone/virtual appointments; these are vitally important appointments as the hormones produced by your body to maintain your pregnancy can affect your control and alterations to your insulin will need to be made throughout. However in between your appointment if you wish to discuss your blood sugar results please contact the diabetes team (numbers below).

You will also see your own local Community Midwife as well as the team at various times and she will give you her contact number at the first booking appointment.

What to expect regarding giving birth:

• At around 34- 36 weeks the team will be having a discussion with you regarding the method of delivery which is appropriate to you, including the timing of delivery which is usually between 37 – 38+6 weeks gestation. The discussion will include vaginal or caesarean section delivery depending on the size of your baby and diabetes control/complications.
• If we need to give you steroids at this point to help mature the babies lung’s if early delivery is planned, then you will require admission to the antenatal ward for a couple of days as steroids increase your blood sugars and an insulin infusion will be required to help control them.
• Your Community Midwife will offer you an appointment at around this time to discuss your birth plan and the Diabetes Specialist Midwife will discuss this with you in the clinic as well, as well as planning for the next pregnancy.
• We will offer you a harvesting of colostrum expression pack if suitable at this time, as your baby is at risk of low blood sugars after delivery and early breast feeding help stabilise this, having colostrum that has been expressed during your pregnancy can help.
• Throughout your labour your blood glucose will be monitored every hour to help maintain them between 4 – 7, this tight control is to reduce the baby having low blood glucose once delivered. An infusion of insulin and dextrose will usually be used to help control them
• Once you have delivered you will usually go back to your pre pregnancy insulin amounts, please be aware you are at risk of low blood glucose now and your control can be slightly relaxed to help reduce this risk. Your diabetes team will have a discussion with you towards the end of your pregnancy.
• Once you are home and settled with baby an appointment will be sent out from your usually diabetes care provider, if you have not received an appointment 3 months following delivery please contact them.

Contact the Diabetes Antenatal Team

• Triage (for example: pain, reduced fetal movements, signs of labour or concerns during your pregnancy): 01302 642711
• Diabetes Specialist Nurses (for discussion on your blood sugars, insulin adjustments):
  Monday – Friday 09.00-17.00:
  Doncaster site:   01302 642611/ 642612 or 01302 366666 ask them to Bleep 1333 or 1388
  Bassetlaw site: 01909 572648/ 572640
  Sat, Sunday or Bank Holidays 09.00 -15.00 both sites contact     07880 052450 or 01302 366666 and ask to Bleep 1333
• Diabetes Specialist Dietitians: 01302 642742
• Diabetes Specialist Midwives: 01302 642897 mobiles: 07971148726 / 07867341233

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