Diabetes in pregnancy

What is diabetes in pregnancy?

Diabetes in pregnancy is known as Gestational Diabetes (GDM). The diagnosis is made when the glucose level in blood is elevated for the first time in pregnancy, as oppose to pre-diabetes, Type 1 or Type II diabetes.  Gestational diabetes is usually detected at routine screening between 24 to 28 weeks. This screening test is called an oral glucose tolerance test (OGTT).  

Gestational Diabetes happens because hormones from the placenta and body have altered the body's requirement for insulin. Gestational diabetes usually goes away after birth unless it was pre-existing.

Risk factors

The more risk factors you have, the more likely you will have Gestational Diabetes. Your obstetrician or fertility specialist may recommend the OGTT earlier than 24 weeks if you have one or more of the following.

• Overweight
• Over 30 years old
• Polycystic ovarian syndrome or insulin resistance
• Family history of type II diabetes
• Gestational Diabetes in previous pregnancy or previously had a large baby

• Of Aboriginal or Torres Strait Islander, Asian , Middle Eastern, Polynesian descent
• Twin pregnancy
• Corticosteroids such as prednisolone, dexamethasone

How is gestational diabetes managed?

10 -20% of patients will need insulin in pregnancy, which means that the majority will control their glucose with simple changes to diet and activity.

1. Education - understanding how your body reacts to food is the first step.
2. Monitoring - as you wont have symptoms, the only way to ensure good control is to monitor your glucose four times a day.
3. Food - establish a healthy eating pattern & adhere to low glycaemic index food. This will prevent surges of high glucose in blood.
4. Exercise - physical activity such as walking or swimming.
5. Medications - insulin is safe and recommended if your glucose is raised despite the above efforts.

Complications

Controlling your glucose as soon as you've been diagnosed will reduce the risk of complications to you and your baby.

​​Risk to my baby

• Large baby
• Miscarriages
• Prematurity
• Still birth
• Low sugars at birth

Risk to me

• Complicated birth
• Caesarean deliveries
• Pre-eclampsia (high blood pressure)
• Urinary tract infections

After delivery care

Do I still have diabetes?

An Oral Glucose Tolerance Test (OGTT) is arranged 6 to 12 weeks after delivery to rule out underlying diabetes.

• Australian guidelines recommend a formal oral glucose tolerance test every two years as you have a 50% chance of developing type 2 diabetes for the next 20 years. As a minimum, you should have this prior to any planned pregnancy.  Prevention and early detection is the key!

How do I prevent diabetes later in life?

• Having diabetes in pregnancy is a sign that you are susceptible to the development of diabetes later in life.  It's possible to prevent or delay the onset of diabetes. The best strategy is to achieve a healthy BMI 20 - 25kg/m2 within the year.
• Have a healthy balanced diet. 
• Be active and include regular exercise every week.