Gestational diabetes (EN)Information for women who are affected by gestational diabetes
Gestational diabetes often develops between week 24 and 28 of the pregnancy. This type of diabetes will only last until the end of your pregnancy. This leaflet provides information on gestational diabetes. What is it, how will it be diagnosed, and what does it mean to you?
What is gestational diabetes?
Since every patient is different, the information below may not describe exactly what happened to you. The diabetes nurse and internist discussed your personal situation with you.
If a woman develops diabetes during her pregnancy, this is often gestational diabetes. Gestational diabetes affects women in one out of ten to twenty pregnancies.
What is diabetes?
When you suffer from diabetes, the control over the blood sugar level (sugar) in the blood is disrupted. The level of sugar (glucose) in the blood is controlled by a hormone called insulin. Insulin enables body cells to take up glucose. Diabetes is diagnosed when the laboratory has established that the glucose level (amount of glucose in the blood) is too high. During the pregnancy, it is important that the blood glucose level stays within a normal range as much as possible.
How does gestational diabetes develop?
The following circumstances (factors) coincide with an elevated risk of gestational diabetes:
- (considerable) overweight or obesity of the mother
- a baby that grows faster than expected in view of the duration of the pregnancy
- too much amniotic fluid
- a family history of diabetes (first degree)
- ethnic background: people with a non-white or non-Caucasian background suffer more often from gestational diabetes in particular and diabetes in general
- gestational diabetes occurred during an earlier pregnancy
- death of one of your children before you gave birth.
Consequences of gestational diabetes
Normally, your body would compensate for a reduced effect of insulin by producing extra insulin. This does not happen or insufficiently so when you suffer from gestational diabetes. That is why your blood glucose level rises too high. Most often, you will not suffer complaints from that in the short term. However, it is important to maintain your blood glucose level at normal values in view of the development of your unborn child.
Consequences for the child
The child receives nutrients from the mother's blood through the placenta. If the mother's blood glucose level is too high, this immediately leads to high glucose intake by the child. This may harm growth of the baby to an extent that it leads to an increased risk of an elevated birthweight (macrosomia). In addition, strong fluctuations of the blood sugar level may result in slower maturing of the baby's lungs. Excessive birthweight may cause extra problems in childbirth. Furthermore, evidence shows that children with high birthweights may run an elevated risk of developing diabetes later in life.
High glucose levels during the last stage of pregnancy will lead to high insulin production by the baby. After childbirth, the supply of glucose from the placenta is cut off. As such, the baby runs a higher risk of developing a blood glucose level that is too low, which may cause problems for the baby. Proper and timely improvement of the mother's blood glucose level may limit these risks.
Consequences for the mother
Gestational diabetes is a warning for the future. Risks of developing permanent diabetes are forty to fifty per cent higher in the first ten years after your pregnancy than for women who did not suffer from diabetes during pregnancy. Moreover, you will almost always develop diabetes again during a new pregnancy. You may limit the risk of developing diabetes by:
- maintaining a healthy weight (adequate for your age and build)
- sufficient exercise
- a healthy diet.
Consequently, it is important to live as healthy as you can. This limits your risk of developing diabetes.
For all of these reasons, it is right that you will be or were examined for development of gestational diabetes. This examination is called a glucose tolerance test. The first test is normally performed during week 24 to 28 of your pregnancy. If you have suffered from gestational diabetes before, or if your child is growing too fast when compared to the duration of your pregnancy, a test may be carried out as of week sixteen. In some cases, the test will also be performed later in your pregnancy.
Based on the result of your glucose test it was established that you suffer from gestational diabetes and this is why you were referred to the diabetes outpatients' clinic.
Overview of blood glucose levels
Below you can see the margins of blood glucose levels. Your diabetes nurse will use this scheme to explain the test results to you.
- Diabetes mellitus (without pregnancy): fasting 7.0 mmol/L, non-fasting 11.1 mmol/L
- Impaired Fasting blood glucose level: 6.1 mmol/L and 6.9 mmol/L
- Normal fasting blood glucose level: 6.0 mmol/L
- Impaired glucose tolerance: provocation test (intake of 50 grams of glucose): after one hour: 7.8 mmol/L ; if 7.2 and < 7,8 mmol/L: further examination: - oral glucose tolerance test (intake of 75 grams of glucose): after two hours: 7.8 mmol/L - if also without extra intake ('established by accident') 7.8 mmol/L
- Gestational diabetes: disturbed fasting glucose level and/or disturbed glucose tolerance
Treatment during pregnancy
The treatment depends on the values that are recorded after the examination by means of self-tests of the blood glucose level. Most often, adjusting your diet in consultation with a dietician will suffice. In some cases, insulin injections are required to achieve the target blood glucose range.
Blood glucose meter
After referral, you will have a meeting with the diabetes nurse. She will give you a brief explanation of your blood examination results and will discuss some of your questions. In order to get a good overview of your glucose levels, we expect you to determine your blood glucose level yourself by means of blood glucose meter at intervals during the day.
We will provide a blood glucose meter for you to take home. The diabetes nurse will explain the use of this meter to you and how often you have to email or call in the values of your blood glucose level to the diabetes nurse (normally once a week). You will also see an internist and/or physician assistant. The doctor will give you additional information about diabetes and the treatment. This will most often take place in group meetings. Some people find measuring blood glucose levels to be a burden. That is because you have to free time for it during your daily tasks. However, you should try to accommodate for measurements during your daily activities.
The dietician will discuss your diet with you and advise you on how to get or keep your blood glucose level within the normal range. The dietician will teach you about the composition of your food, so you can assess how to divide your glucose intake equally over the various meals. You will receive information on carbohydrates that are used by the body to produce glucose. It is still highly important that you do not just eat healthy food, but also enough food with a view to the proper development of your pregnancy. This contact will also take place in group meetings, most often.
When the dietary advice of the dietician does not lead to the target blood glucose values, the internist or physician assistant will be contacted. In that case, insulin injections will be prescribed. When this is required, the internist and diabetes nurse will explain this to you. When using insulin, you run a small chance of having a lower blood glucose level than was actually intended; this is what we call a 'hypo'. Although lower values are less harmful than excessive values, they may cause a miserable feeling, nausea or even fainting. Your diabetes nurse and dietician will explain what you need to do in that case.
If you manage to maintain normal blood glucose levels with an adjusted diet, you can continue your appointments with the midwife - if that is what did before - and deliver your baby at home, if so desired. If you need insulin injections during pregnancy, this is a reason (indication) to have your antenatal check-ups in hospital and give birth in hospital, under supervision of a gynaecologist.
Treatment during childbirth
You do not use insulin
When you manage to maintain glucose levels within the normal range during pregnancy, childbirth will normally also take place without additional problems. In that case, you don't need to deliver your baby early and may deliver your baby at home, if you so desire. Normally, no specific advice applies with regard to childbirth in respect of self-tests of blood glucose levels.
You use insulin
When you have regular check-ups by the gynaecologist because you use insulin or because your baby has a high birthweight, a fetal growth scan will be made every four weeks. Delivery will most often be induced before your due date, at around 38 weeks. When you use insulin, you will be used to taking this before meals. During labour, you will probably not eat. This is why your blood sugar level may fluctuate heavily during childbirth. At that time, you do not need to inject insulin anymore. However, you do need to measure your blood glucose level every hour. Staff members at the Obstetrics Department will also monitor you closely.
If so required, the diabetes nurse or internist on-call may also be consulted during childbirth, also outside office hours. In some cases, you may have to be put on a drip to administer glucose and insulin; more often the intake of a soft drink or an injection of insulin will suffice. The baby's condition will be monitored during childbirth by checking the heart rhythm by means of a cardiotocogram (CTG). When the baby's birthweight is high, childbirth may proceed more difficultly; if progress is insufficient, it may be decided to perform a Caesarean.
Treatment after childbirth
Treatment of your child
When supply of glucose from the placenta stops after childbirth, your child is at risk of developing too low blood glucose levels. In order to monitor this, your baby's blood glucose level will be measured several times after birth. It may be decided that the child will receive additional nutrients to prevent this problem from happening. If so required, the paediatrician may put your baby on a glucose drip and your baby will be admitted to the children's ward.
When you baby's lungs have not yet fully matured, it may be difficult for your baby to breathe after birth. In that case, your baby needs extra breathing support by administering oxygen. This also means that your baby will be admitted to the children's ward.
Treatment of the mother
In most cases, blood sugar levels will be back to normal 24 hours after delivery. If you had to inject insulin during your pregnancy, you can stop this after childbirth, in most cases. Do this in consultation with your internist or diabetes nurse. We do advise you to measure your blood glucose level in the week after delivery and once again after three weeks.
Six to eight weeks after childbirth you will have a check-up appointment at the internist and shortly before that, you will take your last measurement. When your glucose levels are no longer a problem, your GP will be informed accordingly. We will also ask your GP to monitor you because of the risk of developing diabetes in future. Additionally, we also advise you to have your blood glucose level checked at your GP once a year.
Your next pregnancy
In any new pregnancy, the glucose provocation test will be performed earlier in the pregnancy, as from week sixteen approximately. If the test results are not yet too high, the test will be repeated in week 24 to week 28.
If you have questions or wish to report your blood glucose levels, please contact one of the diabetes nurses. On work days they have telephone consultation hours from 8:00 to 8:30 am and from 12:30 to 1:00 pm, at extension (038) 424 23 29. You can also email to email@example.com. Please contact the outpatients' clinic of Gynaecology/Obstetrics for any other questions, at extension (038) 424 56 04.
Will you have an appointment soon? The confirmation of your appointment will state where and when we will see you.