Treatment for gestational diabetes
If you have been diagnosed with gestational diabetes, the chances of having problems during your pregnancy can be reduced by keeping your glucose levels in the target range. This can be done by:
- eating a healthy diet
- exercising for at least 30 minutes every day
- managing your weight gain during pregnancy
- taking medication, if necessary.
You'll be closely monitored during pregnancy and labour to check if treatment is working and for any problems.
Monitoring your glucose levels
If you have gestational diabetes, one of the most important things that you will have to do is to measure your glucose levels every day for the rest of your pregnancy.
Your healthcare team will support you:
- to check your glucose levels
- advise when and how often to measure your glucose levels – most women with gestational diabetes are advised to check before breakfast and 1 hour after each meal
- tell you what levels you should be aiming for – this is usually below 5.3 before breakfast and below 7.8 one hour after each meal (millimoles of glucose per litre of blood or mmol/l).
Your healthcare team will also see you regularly to check your glucose results and make sure that treatment (diet, exercise and any medications) is keeping your glucose levels in the recommended target range and monitor your health in pregnancy.
This can take some getting used to. Some women find it all a bit overwhelming especially during the first couple weeks. But most women do get used to the new healthy pregnancy routines.
Read more about measuring your glucose levels.
What care to expect
It can be worrying if you are diagnosed with gestational diabetes. It is natural to want your pregnancy to go smoothly and to be anxious if something unexpected happens. But once gestational diabetes is diagnosed, you will have extra appointments with specialists that will help you reduce the risk of any possible complications.
This does mean that your experience of pregnancy may be different from what you had expected. But your midwife and diabetes team will be there to support you.
"Gestational diabetes sounded like something small to me, but it was big. It changes your whole pregnancy – I couldn’t have the birth I wanted. It preyed on my mind and I started creating problems in my head, but looking at my son, you’d never know that anything had happened at all."
Your healthcare team
The specialists you will see at your diabetes clinic will depend on what services are available in your local area. But your team may include some of the following people:
- a specialist midwife – here may be a diabetes midwife or clinic lead midwife, who will give you specialist support while you are pregnant, during the birth and after the birth (in addition to your regular, community midwife)
- an endocrinologist or diabetologist – a consultant doctor who specialises in diabetes
- an obstetrician – a consultant doctor who specialises in pregnancy and birth
- a diabetes nurse specialist – a nurse specialising in caring for people with diabetes
- a diabetes dietitian – a healthcare professional who can provide advice on your diet.
These professionals will work alongside the other members of your healthcare team, such as your GP and your community midwife.
Who to contact
Your main point of contact will usually be your diabetes midwife or the diabetes nurse specialist. Make sure you know who to contact and how to get hold of them. Ideally, you should have a direct telephone number or email address and know which days they work.
"My advice to others would be, don’t be afraid to ask questions of the midwives, the consultants, and all the other people carrying out the tests. Ask them how things can affect you, and try to stay healthy."
As well as the routine ultrasound scans offered to all pregnant women, you should be offered extra scans at various points through your pregnancy. This is to check how your baby is growing and how much amniotic fluid is sitting around the baby. The timing of these scans may depend on your individual circumstances.
These scans are important because gestational diabetes can cause the baby to grow larger than usual (known as macrosomia). This can cause complications in labour and giving birth. The team will need to check your baby’s size regularly and will talk to you about the best options for the birth of your baby. Towards the end of your pregnancy, you will be checked regularly to make sure that all is well.
"I was reassured that they were keeping an eye on me. At least I could see the baby was OK."
Your team will give you lots of information and advice about your care leading up to and after the birth.
Extra appointments during your pregnancy
As soon as you are diagnosed with gestational diabetes you will be offered an appointment with a specialist team within 1 week. It will probably be at your local pregnancy diabetes clinic and you should start getting extra care straight away.
You should also have an HbA1c test to check your average glucose status over the last 2 to 3 months. This result can be helpful for understanding whether you had type 2 diabetes before you became pregnant.
You will have contact with the diabetes and antenatal team every 1 to 2 weeks throughout your pregnancy. This may be clinic appointments, or by phone or email to check that everything is fine.
"At first it was quite overwhelming. I was a borderline case but all of a sudden you’ve got a dietitian and an obstetrician. Before, it had been just the midwife."
Because of the risks associated with having gestational diabetes, your healthcare professionals should explain your options for giving birth before you make your birth plan.
If your ultrasound scans have shown that your baby is large, you may be advised to have an early induction (starting labour artificially) or a planned caesarean section.If you’ve had a caesarean section before, you may still be able to give birth vaginally.
If your pregnancy carries on for too long, this may increase the risk of problems for you and your baby. This means you may be advised to give birth before 40 weeks and 6 days.
Your glucose levels will also be monitored carefully during labour and birth.
NICE (2015). Diabetes in pregnancy: management from preconception to the postnatal period. National Institute for health and care excellence https://www.nice.org.uk/guidance/ng3
NHS Choices. Gestational Diabetes https://www.nhs.uk/conditions/gestational-diabetes/ (Page last reviewed: 06/08/2019. Next review due: 06/08/2022)
Royal College of Obstetricians and Gynaecologists (2013) Gestational Diabetes. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-gestational-diabetes.pdf