Gestational Diabetes during Pregnancy (Video)
Pregnancy management
When I was 7 months pregnant, I developed diabetes. I had 8 units of insulin a day. After my baby was born, the tests were normal so I stopped taking insulin. I would now like another baby. My doctor says I could develop permanent diabetes. Another doctor, however, says this is very unlikely – please could you advise me?
You have had what we call gestational diabetes (i.e. diabetes that occurs during pregnancy and then goes away again when you are not pregnant). The chances are that this will recur in all your sub-sequent pregnancies. You may well find that at some stage it doesnot get better at the end of the pregnancy and that you then have permanent diabetes. Even if you do not have further pregnancies, you are a ‘high risk’ (greater than 1 in 2) case for developing diabetes at some stage in the future. Your pancreas produces enough insulin to cope with everyday life but the extra demands of pregnancy are more than it can manage, hence the need for extra insulin. You should pay particular attention to your diet and fitness, and keep your weight at even slightly below your ideal weight for your height. The decision about further pregnancies with the greater risk of developing permanent diabetes is one that you and your partner must make after you understand the facts.
When I had my first baby, I was in hospital for the last 2 months and I was given a caesarean section after 36 weeks of pregnancy. My baby weighed 3.7 kg (8 lb 4 oz) even though it was 4 weeks early. During my most recent pregnancy I was allowed to go into labour at 39 weeks and the baby weighed 3.2 kg (7 lb) – I spent absolutely no time at all in hospital other than going into hospital as I went into labour. Why was there such a big change in treatment?
The last 15 years have seen a dramatic change in our attitudes to the care of pregnancy in women with diabetes. Good blood glucose control is the most important goal and with home blood glucose monitoring this can be achieved in the majority of women without the need for admission to hospital at any stage. It sounds as if your control was worse during your first pregnancy than your second. Early delivery by caesarean section was decided on because the baby had already grown to 3.7 kg by 36 weeks and the doctors were worried that it would become even bigger if left to 38 or 39 weeks. The heavier baby in the first pregnancy was because the high blood glucose you were running resulted in more fat being laid down on the baby. However, during your second pregnancy, when your control was clearly a good deal better, the baby grew at a more normal rate, so that it was at the correct weight when you went into labour at the end of pregnancy.
During my last labour I was given a drip and had an insulin pump up all day. Why was this necessary?
Strict blood glucose control during labour is very important to ensure that you do not put your baby at risk from hypoglycaemia in the first few hours of life. If there is any possibility that your labour may end up with an anaesthetic (e.g. for forceps delivery or possible caesarean section), then the simplest way to keep your diabetes well controlled is with glucose being run into your circulation and matched with an appropriate dose of insulin. With the pump this means that – should an emergency arise – you will be immediately ready.
During my pregnancy I found attending the antenatal clinic a nuisance and I did not like to keep my diabetes too well controlled because, if I did, I had many hypos. Labour and delivery seemed to go quite normally but my baby was rather heavy. He was 4.2 kg (9 lb 4 oz), and had to spend a long time in the Special Care Baby Unit because they said he was hypoglycaemic – how do I avoid all this trouble in my next pregnancy?
If you want to go ahead and have further babies, then it is essential that you change your attitude to the antenatal clinic and to controlling your diabetes throughout the pregnancy. The trouble that your baby had from hypoglycaemia was a reflection of the fact that he had been exposed to a very high glucose concentration throughout pregnancy and had had to produce a lot of insulin from his own pancreas to cope with this extra load of glucose from you. Immediately after birth he no longer had the glucose coming from you but still had too much insulin of his own, hence the hypoglycaemia.
You can prevent this risk in future pregnancies by ensuring that your control is immaculate. This will require you to attend the antenatal clinic on a regular basis and to do frequent blood glucose monitoring to ensure that your control is excellent. If you can do this you should be able to eliminate any risk of hypo-glycaemia in your baby.
Is it all right for me to breastfeed my baby if my blood glucose is too high?
Breastfeeding is generally encouraged these days for all women with babies. There are no special difficulties for women with diabetes and the presence of a slightly raised blood glucose need not worry you too much, provided that your control of your diabetes is not too bad. For the best results with breastfeeding, keep up a high fluid intake and keep an eye on your diabetes, making appropriate adjustments to your insulin dose if necessary.
Breastfeeding is a demanding process in terms of increasing nutritional requirements for anyone, so make sure that you eat regular amounts of carbohydrate to minimize the risk of hypo-glycaemia. If you find this all too much, it is perfectly all right to bottle-feed. Do not breastfeed whilst having a hypo – feed your-self first, so that you and your baby will both be satisfied! Always seek medical advice if you are in any doubt.
My diabetes was fairly easy to control during my pregnancy, but since the birth of my baby it has been more difficult to control, and I am needing much less insulin. I am breastfeeding – could this have anything to do with it?
Various hormones are produced during pregnancy and these lead to an increase in your insulin requirements and alter your body’s metabolism in such a way that obtaining good control is usually easier. After the birth these hormones decrease which means that you need much less insulin, and in many people this dose is even lower than was required before pregnancy. When you are breastfeeding, the dose usually drops even more and you should be prepared to lower your dose of insulin should hypos occur.
I am married to a man who takes insulin to control his diabetes. I have just fallen pregnant, so what special things do I need to do during pregnancy to ensure that it goes smoothly and without complications?
You need take no special precautions other than those taken by all pregnant women, as the fact that your husband has diabetes does not put your pregnancy at any particular risk. It is only when the mother has diabetes that strict control and careful monitoring of blood glucose become essential.
I have been told that I must keep my blood glucose levels as low as possible during pregnancy. Please can you tell me what they should be?
Your blood glucose before meals should be 4–6 mmol/litre and 2 hours after meals no higher than 5–8 mmol/litre.
I am frightened of having hypoglycaemic attacks especially as I have been told to keep my blood glucose much lower during pregnancy. What should I do?
All people treated with insulin should be prepared for a hypo whether or not they are pregnant. Carry glucose or dextrose or something like a mini-Mars bar on you at all times. Most convenient are Dextro-energy tablets. Some people prefer to carry small (125 ml) cans of Lucozade or Coca-Cola (not the diet variety).
Will any hypoglycaemic attacks that I might have during pregnancy harm the baby?
No. There is no evidence to suggest that even a very low blood glucose in the mother can harm the baby.
