If you are already a diabetic, or have just developed the condition in pregnancy, you may be concerned about how it will affect you and your baby. The good news is that, with expert care from medical staff, your pregnancy and birth should both go smoothly.
What is diabetes?
Diabetes is a medical condition that can develop in childhood or later in life. People with diabetes have a problem regulating the amount of glucose (sugar) in their blood. The body normally produces a hormone – insulin – that controls how much glucose remains in the blood and how much is stored. If the body can’t produce enough insulin, abnormally high amounts of sugar will be found in the blood – hence the term ‘high blood sugar’, or hyperglycaemia. The two main types of diabetes are:
Type 1 Diabetes: This develops if the body is unable to produce any insulin.
Type 2 Diabetes: Some insulin is produced, but it may not be enough, or it may not work properly.
Some women develop diabetes during pregnancy, when it’s known as gestational diabetes.
How will I know if I’m diabetic?
At antenatal checks, your midwife will test for sugar in your urine (glycosuria). Women who have sugar in their urine aren’t automatically diagnosed with diabetes, as many of them won’t have it. But they may then go on to have a glucose load, or tolerance, test.
This involves a series of blood tests and a very sweet glucose drink, to determine the body’s ability to break down sugar in the blood. The diagnosis will be made after an abnormal result of a glucose tolerance test.If you have any risk factors for developing diabetes, it may also be suggested that you have a blood test. These include:
- Gestational diabetes in a previous pregnancy
- Obesity
- Close family history of diabetes
- A previous large baby (10lb/4.5kg+)
- Unexplained stillbirth in a previous pregnancy
- Polyhydramnios (excess amniotic fluid around the baby)
How is it treated?
It’s essential that diabetes is well controlled during pregnancy and that blood-sugar levels are kept within normal limits. Your care will be shared among the midwife, consultants and a diabetic nurse. Many women are able to control diabetes through diet and exercise, but some need insulin injections to keep their blood sugar normal. Nausea or vomiting should be reported to your midwife or GP, as this could affect your blood sugar. It’s important to keep all antenatal appointments, as this will optimise the wellbeing of you and your baby.
How will it affect my pregnancy?
Babies of diabetic mothers are more likely to be large (9lb/4kg+), so the baby’s growth and the fluid around it will be closely monitored with ultrasound scans. Women with poorly controlled, insulin-dependent diabetes run a higher risk of having a baby with congenital abnormalities, such as a heart defect. Those with gestational diabetes are more likely to develop pre-eclampsia, but most women with diabetes have a normal pregnancy with a healthy baby. It’s essential to work closely with the diabetic and obstetric team, as this will greatly improve the outcome of the pregnancy and the safe delivery of your baby.
Will I need to have a caesarean section?
The growth of your baby will be closely monitored, and if it’s thought that he’s very large (macrosomia) your labour may be induced. If this is the case, the risk of a caesarean increases. Some women may be advised to have a caesarean if it’s felt they won’t respond favourably to an induced labour. This is a major operation, so the decision to do it won’t be taken lightly.
What happens next?
Some insulin-dependent diabetic women may find it takes a few days for their baby’s blood-sugar levels to stabilise. These newborns may need to go to the special care baby unit for observation, particularly if labour was induced before 37 weeks. Most women with gestational diabetes find it disappears once the baby’s born, but an appointment will still be arranged for three months later to check. The risk of developing Type 2 diabetes increases in women who’ve had gestational diabetes, so they’ll be advised to stick to the diet and exercise regime that was recommended in pregnancy.
