Download Pregnancy and Type 1 Diabetes: What to expect from the RUH

Pregnancy and Gestational Diabetes: What to expect from the RUH antenatal team
What is Gestational Diabetes?
During the later stages of pregnancy (after 24 weeks) hormones produced from the placenta make
your blood sugar (glucose) rise. This is because insulin which is the hormone your body produces to
control you blood sugar, works less well in pregnancy. In most women this does not cause any
problems. In some women the sugar levels are high enough to affect the delivery and the health of
your baby. This is because the extra sugar is turned into fat by your baby and makes it bigger,
especially around its tummy (macrosomia).
You will recently have had a glucose tolerance test (GTT) which has shown that your sugar levels
are above the normal range expected in pregnancy. Your midwife has referred you to this clinic so
that we can help you reduce any risk to you and your baby. The vast majority of women with
gestational diabetes have a normal healthy baby.
First Appointment:
The midwife will take your details and talk to you about the clinic. The diabetes team will discuss
your GTT results, and show you how to monitor your own blood glucose levels. Ideal blood sugars
are 4-6 before meals and up to 8, 2 hours after your meal.
The dietician will advise you on dietary changes which will help to reduce your sugar levels.
The obstetricians will assess how big baby is and order a growth scan at subsequent visits if
clinically indicated.
We will then see you the following Wednesday or Friday to see how your sugar levels have been. If
you are worried by your results after the first two days or at any other time please contact one of the
Diabetes Specialist Nurses (the relevant telephone number(s) will be given to you in the clinic, and
are also listed at the end of this information sheet)
Subsequent Appointments:
You will be seen by members of both the diabetes and the obstetric teams. Many women are able to
control their sugar levels on diet alone all the way through pregnancy, however sugar levels tend to
continue to rise until you are about 36 weeks. If your sugar control is not very good we will suggest
you go on to metformin tablets or insulin injections given 1-4 times a day depending on the times
when your sugar levels are high.
At subsequent appointments we will help you to adjust your medication as necessary. At around 36
weeks blood sugars tend to level off and may even fall in the last few weeks of your pregnancy. All
these changes are driven by the placental hormones and vary from pregnancy to pregnancy and
from woman to woman.
Growth Scans:
If the obstetricians think it is necessary you will have a scan to check the baby is growing well and
its tummy is not getting too fat (macrosomia). Depending on the results further scans may be
performed, usually at 4 weekly intervals
Delivery:
After the initial two visits we tend to see you every two weeks, although this may vary according
the way the pregnancy is progressing.
Most women with gestational diabetes will be delivered a little early dependent on how difficult it
has been to control the sugar levels. The baby is considered mature after 37 weeks. There is
evidence in this case that leaving the baby beyond term may increase the chance of the placenta
failing and the baby becoming distressed. If you are on diet alone and the baby is growing well then
you should deliver by your expected date.
The obstetricians will discuss the method of delivery .This will depend on how big the baby is and
the method of delivery for any previous babies you may have had.
If you are on insulin you will normally have an insulin drip put up during the delivery to control
your sugars, and this will be stopped once baby is delivered. If you are being treated with tablets or
diet alone this may not be necessary.
Your baby has an increased risk of newborn problems, the most common being low sugar levels
(hypoglycaemia). The best way to avoid this is to keep your sugar levels as good as possible right
up to the time of delivery. The baby may need to be observed on the special care unit but will be
returned to you as soon as the paediatricians are happy that the baby is doing well.
After Delivery:
If you were on insulin or tablets then you should stop these as soon as baby is born.
You should check your blood sugars for a further 48 hours after delivery. If they are within the
normal range (your pregnancy target blood sugars) then you can stop testing. If they are outside this
range then speak to one of the diabetes specialist nurses, preferably before going home. The
midwives can organize for the diabetes nurse to review you before discharge from hospital.
At 5 weeks after delivery we would suggest you have a repeat glucose tolerance test (GTT) to
assess your ability to control your blood sugar now that you are no longer pregnant. This can be a
useful indicator of your future risk of diabetes. We will discuss your GTT results in the antenatal
clinic and advise you on the best ways to avoid future problems.
We recommend that all ladies with a history of gestational diabetes have, at least, a three yearly
fasting glucose test performed at their general practice.
Diabetes Specilaist Nurses Contact Numbers :
Helen Griffiths/Ainslie Lang (RUH) 01225 824198
Sally Wylie (Bath) 01225 824173
Bernadette Hall (Trowbridge) 01225 711443
Nikki Hillier (Chippenham) 01249 456483
Martine Saunders (Frome) 01373 454778
Antenatal Clinic 01225 824650/824645
Delivery Suite 01225 824447
01225 824847