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1 Women and Children s Directorate Gestational diabetes mellitus Milton Keynes Hospital NHS Foundation Trust Standing Way, Eaglestone, Milton Keynes, MK6 5LD Telephone: Page 1 of 8

2 What is gestational diabetes mellitus? Gestational diabetes mellitus (GDM) is a common condition which affects 3-5% of pregnant women, particularly those who are overweight, have a family history of diabetes or who are from an ethnic minority background. It usually starts in the middle or towards the end of pregnancy, and occurs because your pregnancy hormones can alter the way glucose (sugar) is used in the body, causing it to remain in the blood instead of being used elsewhere in the body for energy. Raised blood glucose levels in pregnancy can pass through to the developing baby, causing it to grow to be bigger than it would have been otherwise, and possibly leading to an increased risk of complications during labour and delivery. Most women do not feel unwell with GDM, and often do not have any symptoms. However, symptoms of high blood glucose are increased thirst and increased need to pass urine. You may show glucose in your urine sample, or your midwife may notice that your baby is larger than expected or it may have extra fluid around it (polyhydramnios). Page 2 of 8

3 Screening for gestational diabetes Women who are at risk of developing GDM will be identified at booking and checked to make sure that they don t already have diabetes. They will then be offered a test called an Oral Glucose Tolerance Test (OGTT), usually around 28 weeks. If you are found to have GDM you will be contacted by the Diabetes Lead Midwife and taught how to test your own blood sugar at home on a daily basis. This is a simple and relatively painless procedure, and allows us to see what happens to your blood glucose on a daily basis. Treatment for gestational diabetes Many women can control their GDM by adjusting their diet and taking more exercise. You will be offered an appointment with a dietician, and will also be in regular contact with the Diabetes Lead Midwife. It is important to reduce consumption of sugary foods like cakes, biscuits and soft drinks, and to eat a diet which is low in fat and high in fibre (see diet sheet). If your blood glucose levels are still raised after changing your diet and lifestyle, you will be offered treatment to control them. This could either be tablets (called Metformin) or insulin, or a mixture of both. You will be offered extra care in the Joint Clinic which is held in the Maple Unit on a Wednesday afternoon, and this will include extra growth scans to monitor the Page 3 of 8

4 baby s growth. A decision may be made to induce your labour early (after 38 weeks) if the baby seems to be growing too much. How will it affect my labour? If you are treated by diet alone, GDM should not affect your labour. If you are on treatment, your blood glucose will be checked regularly during labour and you may need an insulin drip to control it. Most women whose blood glucose levels have stayed within the safe range deliver their babies without complications, and you may expect a normal delivery. Will it affect my baby? Having high blood glucose can affect the baby s growth and cause it to grow larger, making delivery difficult. Shortly after birth, the baby may also continue to produce extra insulin and this can cause its blood sugar to drop too low (hypoglycaemia). The baby will be observed for this during the first 24 hours while still in the hospital. This does not mean that the baby has diabetes, and it will return to normal once its feeding pattern is established. Breastfeeding is strongly recommended and research suggests that this may protect against childhood diabetes and obesity. Page 4 of 8

5 What will happen after the baby is born? Generally your blood glucose level will return to normal, and this will be checked before you go home. You will then be asked to have a fasting blood glucose test with your GP before coming back to the Maple Unit at 6-8 weeks postnatally. If your blood glucose does not return to normal, you will be offered a blood test to check if your diabetes is still present. Future lifestyle choice Having GDM increases your risk of developing diabetes later in life (30-80%). It is most common in women who are overweight and in those who have a family history. You will be advised to have an annual blood glucose test with your GP, and to carry on with the healthy lifestyle changes recommended during pregnancy. Symptoms of diabetes to look out for are increased thirst, passing urine more frequently, weight loss and excessive tiredness. If you become pregnant again, you are likely to develop GDM again, therefore you should inform your midwife or GP as soon as possible so that you can be referred to the Diabetes Lead Midwife as soon as possible. Page 5 of 8

6 Dietary advice Avoid sugar, sugary foods and drinks (see list on opposite page for alternatives). All foods that are not high in sugar can be eaten in moderate amounts. Try to make sure you eat regularly, at least 3 meals or snacks a day. Include some starchy carbohydrate at each meal (bread, potatoes, pasta, rice, chapatti, cereals, etc). Try to include plenty of lean meat, chicken, fish, eggs, and lots of vegetables and salad. Also, include dairy products such as milk, yoghurt and cheese. Page 6 of 8

7 Foods to Avoid or Reduce Sugar, glucose, honey Sweets, chocolates and mints Jam and marmalade Fizzy drinks, e.g. cola, Lucozade Ordinary squash Tinned fruit in syrup Milk puddings, e.g. custard, rice pudding Ice lollies and rich ice cream Low fat yoghurts or ordinary yoghurts Sugar coated breakfast Alternatives Small amounts of sweeteners eg Splenda Small amounts of very dark chocolate Reduced sugar jam or marmalade Small amounts of diet fizzy drinks No added sugar squash Tinned fruit in natural juice Milk puddings made with less sugar or small amounts of sweeteners e.g. Splenda Plain ice cream Low sugar or plain yoghurt (less than 80 kcal per 125g pot) Plain cereals, e.g. Page 7 of 8

8 cereals, e.g. Frosties, Coco Pops, Crunchy Nut Cornflakes, Sugar Puffs Rich cakes Rich biscuits, e.g. Chocolate covered or cream filled Take-aways and very fatty foods Branflakes, porridge, low sugar Muesli, Weetabix, Shredded Wheat Tea cakes, scones, malt loaf Plain biscuits, e.g. Rich Tea, Digestives Small portions occasionally We ask information about you so that you can receive proper care and treatment. This information remains confidential and is stored securely by the Trust in accordance with the provisions of the Data Protection Act Author: Jan Liddie Reviewed By: Date written: 01/2011 Review Date: 05/2014 Version No: MIDW/PI/47 Milton Keynes Hospital NHS Foundation Trust Standing Way Eaglestone Milton Keynes, MK6 5LD Milton Keynes Hospital NHS Foundation Trust Page 8 of 8

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