Managing Diabetes for a Healthy Pregnancy

Diabetes can present challenges during pregnancy, but with careful management most women go on to have healthy babies. This article outlines the key things to know about gestational diabetes and pre-existing diabetes in pregnancy.

Around 16 in 100 pregnant women in the UK develop gestational diabetes. This type of diabetes arises during pregnancy, usually after 28 weeks. Monitoring blood sugar levels and following a healthy diet can help manage gestational diabetes.

Women with pre-existing diabetes need expert care before and during pregnancy to avoid complications. Controlling blood sugar levels before conceiving reduces the risk of birth defects and miscarriage.

Diabetes that arises in pregnancy is known as gestational diabetes. This affects around 5-6% of pregnant women in the UK. Some women have pre-existing type 1 or type 2 diabetes before getting pregnant. With expert care before and during pregnancy, most women with diabetes can achieve good outcomes.

What Is Gestational Diabetes?

Gestational diabetes causes high blood sugar levels that start in the second or third trimester of pregnancy. The mother’s body becomes resistant to the hormone insulin, which controls blood sugar.

The placenta also releases hormones that raise blood sugar. This provides more energy for the growing baby but can overwhelm the mother’s system.

Many women have no symptoms. Gestational diabetes is usually detected during routine blood sugar testing around 24-28 weeks. Symptoms can include:

  • Excessive thirst and frequent urination
  • Fatigue
  • Blurred vision
  • Recurrent infections like thrush

Who Is at Risk of Gestational Diabetes?

Certain factors increase the chances of developing gestational diabetes:

  • Being overweight – body mass index over 30
  • Previous birth of a large baby over 4.5kg (9lb)
  • Previous gestational diabetes
  • Family history of type 2 diabetes
  • Ethnicity – South Asian, black Caribbean, Middle Eastern

Screening and Diagnosis

Screening for gestational diabetes is recommended between 24-28 weeks of pregnancy. This involves drinking a sugary solution then testing blood sugar levels after 1 hour and 2 hours.

If blood sugar is above set thresholds, gestational diabetes is diagnosed. Some women at high risk get tested earlier in pregnancy.

Symptoms of High Blood Sugar

As well as routine screening, symptoms can indicate gestational diabetes. Contact your midwife or maternity team promptly if you experience:

  • Increased thirst and frequent passing of large amounts of urine
  • Tiredness and lethargy
  • Blurred vision
  • Recurrent vaginal thrush infections
  • Slow healing of cuts and wounds

Reporting symptoms allows prompt treatment to avoid complications. Monitoring blood sugar gives a clear picture of levels.

How Is Gestational Diabetes Managed?

Lifestyle adjustments like diet and exercise may be enough to control gestational diabetes. Eating small frequent meals and avoiding sugary foods helps manage blood sugar.

Some women need medication or insulin injections if lifestyle measures aren’t sufficient. Frequent monitoring helps guide treatment.

Taking folic acid supplements reduces the risk of birth defects like spina bifida. Regular eye and kidney checks are advised to catch related complications.

What Are the Risks of Gestational Diabetes?

Potential risks and complications include:

  • Premature birth before 37 weeks
  • Miscarriage or stillbirth
  • Excessive birth weight over 4kg (8lb 13oz)
  • Birth injuries during delivery
  • Congenital abnormalities
  • Pregnancy infections
  • Low blood sugar in the newborn

Following medical advice minimises these risks. Most women with gestational diabetes go on to have healthy pregnancies.

Blood Sugar Monitoring in Pregnancy

Expectant mothers with diabetes need to check blood sugar levels frequently, ideally 4-6 times per day. Levels outside the target range may require treatment adjustments.

Monitoring involves pricking the finger to obtain a drop of blood. This is placed on a testing strip in a glucose meter. The meter displays the result.

Records of daily readings allow healthcare professionals to assess control and change medication if needed.

Some glucose meters provide continuous monitoring. A sensor under the skin tracks interstitial fluid glucose levels. Data is sent wirelessly to a smartphone app.

Diabetes Risks in Pregnancy

Women with pre-existing type 1 or type 2 diabetes face higher risks during pregnancy:

  • Higher chance of birth defects and miscarriage
  • Preterm delivery
  • Stillbirth late in pregnancy
  • Rapid progression of diabetes complications like eye and kidney disease

Tight control of blood sugar before and during pregnancy reduces risks. Starting pregnancy with an HbA1c level below 6.1% is ideal.

Women with diabetes need specialist obstetric care and extra monitoring. Amending medication or starting insulin helps manage blood sugar levels.

Management of Diabetes in Pregnancy

  • Preconceptual advice from a diabetes specialist
  • Losing excess weight if overweight
  • Taking folic acid supplements
  • Starting pregnancy with HbA1c below 6.1%
  • Adjusting diabetes medication – tablets or insulin shots
  • Testing blood sugar 4-6 times per day
  • Following a healthy diet with no added sugars
  • Light exercise like swimming or walking
  • Regular checks for diabetic eye and kidney disease
  • Extra ultrasound scans to monitor the baby’s growth
  • More frequent antenatal appointments
  • Tight control of blood sugar levels during labour
  • Feeding the baby as soon as possible after birth

Controlling diabetes requires commitment but offers the best chance of a healthy pregnancy. Most women with diabetes have healthy babies following expert advice.

Photo by 🇸🇮 Janko Ferlič on Unsplash

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