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  1. 7201-Gestational diabetes (EN)

Information for women who are affected by gestational diabetes

Gestational diabetes often develops between the 24th and 28th week of pregnancy. This type of diabetes will go away after your baby is born. This leaflet provides information on gestational diabetes. What is it, how will it be diagnosed, and what does it mean for you?

What is gestational diabetes?

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 absorb glucose. Diabetes is diagnosed when the laboratory has established that the glucose level (amount of glucose in the blood) is too high. During pregnancy, it is important that the blood glucose level stays within a normal range as much as possible.

What is gestational diabetes?

During pregnancy, you need more insulin to process the sugar from your diet. This is partly due to a change in your hormonal balance. Sometimes the pancreas is no longer able to cope with this increased demand for insulin, resulting in blood sugar levels that are too high. That is what we call gestational diabetes. Usually this only occurs after the twentieth week of pregnancy. Approximately one in fifteen pregnant women will get gestational diabetes.

Gestational diabetes can happen to any pregnant woman, but you are more likely to get gestational diabetes:

  • if you are overweight;
  • if you have a first-degree family member who has diabetes;
  • if you are of Hindu, Moroccan or Turkish origin;
  • if you had gestational diabetes during a previous pregnancy;
  • if you have given birth to a baby with a birthweight of 4000 grams or more.

Signs of gestational diabetes are:

  • being very thirsty, particularly at night;
  • needing to go to the toilet frequently;
  • your baby being clearly much bigger than is normal for the particular stage of pregnancy.

However, there are usually no symptoms and you don't notice anything.

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 baby.

Consequences for the baby

The baby 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 baby. This may harm growth of the baby to an extent that it leads to an increased risk of excessive birthweight (macrosomia). In addition, strong fluctuations in blood sugar levels may result in slower maturing of the baby's lungs. Excessive birthweight may cause extra problems during labour. Furthermore, evidence shows that children with high birthweights may run a higher 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 giving birth, the supply of glucose from the placenta is cut off. As such, your baby runs a higher risk of developing 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 can 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 in as healthy a way as you can. This limits your risk of developing diabetes.

Research

For all of these reasons, it is important 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 baby is growing too fast compared to the stage of your pregnancy, a test may be carried out from week 16. In some cases, the test will also be performed later in your pregnancy. More information about glucose measurement or a glucose tolerance test and how you can prepare for the test (Dutch).

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.

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 e-mail 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's 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.

Dietician

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 the carbohydrates that are used by the body to produce glucose. It is still highly important that you do not just eat healthy food, but that you also eat enough food with a view to the proper development of your pregnancy. This contact will also generally take place in group meetings.

Insulin injections

When the dietary advice of the dietician does not result in the target blood glucose values, the internist or physician assistant will be contacted. In that case, insulin injections will be prescribed. If 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.

Pregnancy check-ups

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) for you to have your pregnancy check-ups in the hospital and to give birth in the hospital, under the supervision of an obstetric care provider (this can be a gynaecologist, doctor in training or clinical midwife, whereby the latter are always supervised by a gynaecologist).

Treatment during labour

You do not use insulin

If you manage to maintain glucose levels within the normal range during pregnancy, you will go through labour normally without any additional problems. It will not be necessary for you to be induced to give birth early and you can have a home birth if you wish. Normally, no specific advice applies with regard to labour regarding self-tests of blood glucose levels.

You use insulin

If you are having hospital check-ups because you are using insulin or because your baby has a high birth weight, you will need to have an ultrasound every four weeks to keep track of your baby's development. Delivery will most often be induced before your due date, at around 38 weeks. If 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 labour. 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 necessary, the diabetes nurse or the on-call internist can always be consulted when you are in labour, even 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 labour by checking the heart rhythm by means of a cardiotocogram (CTG). If your baby has a high birthweight, you may find that labour is more difficult; if labour fails to progress, the decision may be made to perform a Caesarean.

Treatment after giving birth

Treatment of your baby

After giving birth, the supply of glucose from the placenta is cut off. As such, your baby runs a higher risk of developing a blood glucose level that is too low. In order to monitor this, your baby's blood glucose level will be measured several times after birth. It may be decided to give your baby an extra feeding to avoid this problem. 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, in most cases you will no longer need to do this after you have given birth. Do this in consultation with your internist or diabetes nurse. We recommend that you measure your blood glucose level in the week after delivery and once again after three weeks.

Six to eight weeks after you have given birth, 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, usually around the 16th week. If the test results are not yet too high, the test will be repeated in week 24 to week 28.

Contact

About Diabetes

If you have questions or wish to report your blood glucose levels, please contact one of the diabetes nurses. On working days, you can contact them for a telephone consultation from 8.00 - 8.30 a.m. and from 12.30 - 1 p.m. on (038) 424 2150. You can also send an e-mail to diabetesverpleegkundigen@isala.nl.

If you have any questions about the test, please call the GP line [ huisartsenlijn] of the Clinical Chemical Laboratory, which can be contacted from Monday to Friday between 7.30 a.m. and 5 p.m on (038) 424 2468.

About your pregnancy

If you have any questions after reading this information or would like more information, please ask your obstetric care provider for an explanation. We recommend that you write down your questions. You can also contact a member of staff from our Outpatient Clinic for Gynecology/Obstetrics on (038) 424 3555.

Do you have an appointment soon? The confirmation of your appointment states where and when you are expected.

If you are worried or have any questions (outside office hours) that cannot wait, then please call the emergency number: +31 (0) 38 424 81 61.

23 november 2018 / 7201

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