Planning future pregnancies If you have been diagnosed with Diabetes Mellitus or previous Gestational Diabetes, research now

shows that raised blood sugar level increases the risk of miscarriage, infertility, fetal anomalies and still birth. Pre-conception care is recommended by CEMACH (Confidential Enquires into Maternal and Child Health) for a successful next pregnancy. Help yourself: Having previously had Gestational Diabetes, you will get it again in any future pregnancies Plan your next pregnancy Keep blood sugar levels within the recommended targets Take folic acid for up to 12 weeks before you try for a baby Use contraception until your blood sugar levels are in target Maintain an healthy balanced diet and aim for a healthy weight Refer yourself or ask your GP to refer you to the preconception clinic (if you are registered with a South Manchester GP) For further information you can contact: Diabetes Specialist Nurse 07977 463838 Diabetes Midwife at Wythenshawe Maternity0161 291 2931 Diabetes UK www.diabetes.org.uk Diabetes Care-line Tel: 0845 120 2960 CEMACH www.cemach.org.uk Pregnancy in women with type 1 and type 2 diabetes Tel: 020 7486 1191 NICE (National Institute for Health and Clinical Excellence) http://www.nice.org.uk/ Tel 0845 003 7780
Authors: Sue Leigh Atkins / Helen Bowker Editorial Board Number: 0842/09 Issue Number: 01 Reviewed on: April 09 Review Date: April 09

Gestational Diabetes Mellitus

Patient Information Leaflet

What is Gestational Diabetes? Gestational Diabetes is one of the most common medical conditions to develop during pregnancy. It occurs in 2-9% of all pregnancies in the UK. It is a condition that starts during pregnancy, generally around 24-26 weeks gestation, where higher than normal amounts of sugar are found in your blood. Generally, sugar comes from food; either refined sugars, such as jam, chocolate, pure fruit juice or from digested starchy foods, such as cereal, bread, chapattis, pasta, rice and potatoes. Your body produces a substance called insulin, which moves sugar from your blood stream into your muscles, main organs and brain for energy. This process lowers your blood sugar levels. During pregnancy, the hormones produced by the placenta (oestrogen and progesterone) prevent insulin from doing its job properly causing raised blood sugar levels. You need more insulin during pregnancy to overcome the effects of oestrogen and progesterone, and also because your growing baby needs more energy. Some womens, bodies do not make enough insulin and so Gestational Diabetes develops. This does not mean that your baby will have diabetes. Specific factors increase the risk of developing Gestational Diabetes including; Ethnicity: being of South Asian or West African origin Being overweight BMI more than 30 Having parents or siblings with diabetes Having previously had a big baby (more than 4.5KG) Previous gestational diabetes

Postnatal check: You will need to have a blood test to confirm that the Gestational Diabetes has stopped in six weeks. This will be a fasting blood test and you will be advised not to eat or drink from midnight, before the test. This appointment will be sent to you in the post with instructions. The Diabetologist will see you to discuss the result in the joint clinic. The fasting blood test should be repeated every year by your GP, as you are at risk of developing Type 2 diabetes in the next 5-10 years. Every three years, it is recommended that you have an Oral Glucose Tolerance Test arranged by your GP. Contact your GP or practice nurse if you experience any of the following; Frequent urination, particularly at night Feeling thirsty and drinking more Feeling tired and lethargic Having a dry mouth Blurred vision Recurring infections such as boils, thrush, coughs, colds or urine infections Slow healing of the skin or gums Tingling in your hands or feet This is an ideal time to reduce your risk of developing Type 2 diabetes in the future. Consider making appropriate lifestyle changes, such as: Aiming for a healthy weight Maintain regular exercise e.g. walking, swimming, tennis, and cycling etc In 5% of women, the diabetes will remain and you will be classified as having Type 2 Diabetes (which you will have for life). The care to expect will be discussed with you.

How can I help myself? Why is it important to control blood sugar levels during pregnancy? Who will I see at ANC appointments? A Diabetologist, a Diabetes Specialist Nurse, an Obstetrician, a Diabetes Midwife and a Dietitian. We are here to offer advice and support for a healthy pregnancy. The Diabetologist is a consultant who specialises in caring for women with diabetes. He will advise you of any lifestyle changes that you may need to make and oversee your diabetes care in the ANC. A Diabetes Specialist Nurse and Diabetes Midwife provide support, advice and skills in caring for women with diabetes. They will teach you how to check your own blood sugar levels they will offer advice regarding light exercise, when and how to take tablets or insulin injections safely and help you keep good blood sugar levels. It is likely that you will have weekly contact with these people for ongoing support to ensure good diabetes control throughout your pregnancy. An Obstetrician will monitor you and your baby throughout pregnancy. Your babys growth will be monitored, which may require more frequent scans. If you are currently under an Obstetrician who does not specialise in diabetes in pregnancy, you may be transferred to the joint diabetes/ obstetric team. A Dietitian will offer advice and support for maintaining a healthy diet and lifestyle throughout pregnancy. They may offer suggestions to help you make changes to help keep blood sugar levels as near normal as possible. Diet and Activity: Eat a healthy, balanced diet; 3 meals a day, with light snacks Have regular meals as discussed with your dietitian (starch at each meal which releasing energy slowly) Limit sugary foods (these will raise your blood sugar levels quickly) Try to eat up to 5 portions of fruit/ vegetables a day Discuss with the Dietitian any concerns Take regular daily gentle exercise (walk 20-30mins a day) Blood Glucose Monitoring: You will be given a blood glucose testing kit and trained how to use it. You will be advised when to telephone the Diabetes Specialist Nurse or Diabetes Midwife The recommended levels for blood sugars during pregnancy are o Before breakfast - Less than 5mmols o 2 hours after breakfast, lunch and evening meal - Less than 7mmols If the results are all greater than 10mmols after the first day, you should contact your Diabetes Specialist Nurse or Diabetes Midwife Tablets or/ and Insulin: You may find that changing your diet and activity levels will be enough to keep your blood sugar levels within a good range. If this is the case, then you should continue to check your blood sugar levels and keep weekly contact with your Diabetes Specialist Nurse or Diabetes Midwife. If your blood sugar levels remain above the recommended target and you have changed your diet and activity levels, this is not your fault. It is due to the effects of the pregnancy hormones (oestrogen and progesterone) which prevent insulin from working properly. In this case, it is beneficial to start tablets or insulin, which will be discussed with you. Taking tablets or insulin is safe in pregnancy. The Diabetes Specialist Nurse or Diabetes Midwife will teach you how to 3 4

inject insulin safely. Will I need to be induced? Not necessarily. If your diabetes is well controlled, you are not on insulin and there are no problems with your pregnancy. However, your Obstetrician may offer you induction of labour before term, if he thinks that this is necessary. Some women may need to be delivered by caesarean section. This will be discussed in detail with you at around 36 weeks of pregnancy. What will happen in labour? Your blood sugar level needs to be controlled in labour, and this will require an insulin infusion (drip). Insulin may be injected directly into a vein by a continuous pump. If you have gestational diabetes and have not needed to use either tablets or insulin to control your blood glucose you will probably not need this. However, eating during labour is discouraged; this will be explained to you in more detail at the time. Close monitoring of your baby will be essential in labour to avoid complications. The midwife caring for you in labour will explain how this can be achieved. Will Gestational Diabetes go away once my baby is born? In 95% of women, Gestational Diabetes stops as soon as the placenta is delivered. Your blood sugar levels will return back to normal and you will not need to take tablets or insulin. It is recommended that you continue with a healthy diet and regular activity. You will need your blood sugar level checking 3-4 times per day on the postnatal ward, to ensure they are settling with normal ranges. Breast feeding is encouraged as it offers vital protection to your baby, it helps maintain normal blood sugar levels in your baby, and helps maintain your babys normal blood sugar levels. Anyone can breastfeed successfully with a little help at the beginning and it helps you reduce your weight. Visitors - visiting times are 2pm-5pm and 6pm-8pm on the ward. It is usually best to keep to close family and friends after your operation. What happens following diagnosis? You will be given an appointment to be seen in this clinic. Your first appointment is likely to be a lengthy one (approximately 2hours). You will need a scan, further blood tests and will meet professionals from both the obstetric and diabetes teams. Bring a drink, a snack and something to read to pass the time. It is important to attend the Antenatal clinic (ANC) every 2 weeks to speak with the healthcare professionals from both the teams. The two teams work with you, with the aim of promoting a positive experience of pregnancy, a healthy baby and preventing problems that Gestational Diabetes can cause. These problems include: Additional fluid in your womb and around the baby which can feel uncomfortable and may lead to your baby being born too early. Excess sugar floating in your blood stream can pass to your baby and cause it to put weight on. This may cause your baby to grow too big, leading to problems during delivery. If your blood sugars are high throughout pregnancy, your baby will produce insulin to use the sugar and store as fat. Once your baby is born the raised sugar level stops quickly. There is a risk that your baby may have low blood sugar level in the first 24 hours. Your baby will need frequent blood tests and some babies may need care in the SCBU

Why is it important to control blood sugar levels during pregnancy? To protect your babys development of heart, lungs and spine To reduce the risk of problems during delivery To reduce the need for a Caesarean section