diabetes in pregnancy

Overview

Diabetes in pregnancy, also called gestational diabetes, is a condition where your blood sugar levels become higher than normal during pregnancy. It usually starts in the second half of pregnancy and often goes away after the baby is born. It happens when your body cannot make enough of the hormone insulin, which helps sugar from food enter your cells for energy.

Yes, it is quite common. In the UK, about 1 in 20 pregnant women develop gestational diabetes, and it is becoming more common worldwide.

It affects pregnant women who did not have diabetes before pregnancy. Some women have a higher chance of getting it, especially if they are over 25, have a family history of diabetes, are overweight, or belong to certain ethnic groups.

Symptoms

Common symptoms

• Most women do not notice any symptoms, which is why routine screening is important.
• Less often, you may feel unusually thirsty, need to urinate more often, or feel very tired.

Causes

Main causes

• During pregnancy, the placenta makes hormones that can block the action of insulin in your body. This is called insulin resistance.
• If your pancreas cannot produce extra insulin to overcome this resistance, your blood sugar levels rise.
• Gestational diabetes is not caused by eating too much sugar, but diet can affect how well your body manages sugar.

Risk factors

• Being overweight or obese before pregnancy
• Having a family history of type 2 diabetes
• Being over 25 years old
• Having had gestational diabetes in a previous pregnancy
• Having polycystic ovary syndrome (PCOS)
• Belonging to certain ethnic groups, including South Asian, Black African-Caribbean, or Middle Eastern
• Having previously given birth to a large baby (over 9 pounds)

When to see a doctor

See a doctor urgently if:

• If you have any symptoms of high blood sugar such as extreme thirst, frequent urination, and tiredness, contact your midwife or doctor.
• If you notice decreased baby movement, seek help quickly.

Book a routine appointment if:

• All pregnant women are offered a glucose tolerance test between 24 and 28 weeks of pregnancy. This test is part of routine prenatal care.

Diagnosis

Gestational diabetes is diagnosed with a blood test called the oral glucose tolerance test. You will be asked to drink a sugary drink, and your blood sugar is checked at intervals to see how your body handles sugar.

Tests that may be done

• Oral glucose tolerance test (OGTT)
• Fasting blood sugar test (sometimes done first)

What to expect at your appointment

The test takes about 2 hours. You will need to fast overnight. Your blood is taken before the drink, then again at 1 hour and 2 hours after the drink. You may feel slight nausea, but it goes away.

Treatment

Treatment focuses on keeping your blood sugar levels within a target range. Many women can do this with healthy eating and physical activity. Some need extra help through medication.

Self-care at home

• Eat regular meals and choose foods that release sugar slowly, like whole grains, vegetables, and lean protein.
• Move your body every day, such as walking or swimming, after checking with your doctor.
• Monitor your blood sugar levels as your care team advises, usually with a small finger-prick device.
• Keep a record of your readings and bring it to appointments.

Medical treatments

If diet and exercise are not enough, your doctor may suggest blood sugar-lowering medication, such as metformin, or insulin injections. These are safe in pregnancy when recommended by your doctor and do not harm your baby.

When is surgery considered?

Surgery is not used to treat gestational diabetes. If you need extra care during delivery, your birth plan may be adjusted to keep you and your baby safe.

Living with this condition

Managing gestational diabetes means making small changes to your daily routine. You will check your blood sugar regularly, eat balanced meals, and stay active. Most women get into a rhythm quickly.

Lifestyle tips

• Choose water or sugar-free drinks instead of sugary sodas.
• Include vegetables at every meal.
• Learn to read food labels for sugar content.
• Prepare healthy snacks ahead of time.

Diet and exercise

Eat at regular times and include a mix of protein, healthy fats, and high-fiber carbohydrates like oats, whole-wheat bread, and lentils. Try to be active after meals, for example a 10-minute walk, to help manage sugar spikes.

Mental health and emotional wellbeing

A diagnosis of diabetes during pregnancy can feel overwhelming and bring up worries about your baby's health. It is normal to feel anxious or low. Talk to your partner, friends, or healthcare team about how you are feeling. Ask about counseling or mental health support if you need it.

Prevention

You cannot always prevent gestational diabetes, but you can lower your risk by starting pregnancy at a healthy weight, eating well, and staying active. If you have risk factors, your doctor may offer early testing.

Vaccines

Vaccines are not related to gestational diabetes, but it is important to have your routine pregnancy vaccinations, like the flu shot, to protect you and your baby.

Screening programmes

Screening for gestational diabetes is offered to all pregnant women, usually between 24 and 28 weeks. If you have certain risk factors, you may be offered a test earlier in pregnancy.

Complications

If left untreated

• Your baby may grow larger than average, which can make delivery harder.
• You may develop preeclampsia, a serious condition involving high blood pressure.
• Untreated high blood sugar can cause preterm birth or stillbirth, though this is rare with good care.

Long-term outlook

With the right care, the great news is that nearly all women with gestational diabetes give birth to healthy babies. Most of the time, blood sugar returns to normal shortly after birth. Your care team will support you through every step and give you a plan for the future.

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