Symptoms and Signs of Gestational Diabetes in Pregnancy

(10 minute read)

Symptoms and Signs of Gestational Diabetes in Pregnancy

Gestational diabetes is a type of diabetes that can occur during pregnancy. You may have no history of diabetes and still develop gestational diabetes. The good news is that with a controlled diet and exercise the condition and associated risks can be managed by most women. After your baby is born, gestational diabetes goes away on it’s own. Keep reading so you understand the condition, associated risks and how to navigate the maternity system if you have developed gestational diabetes.

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How does gestational diabetes occur?

Babies need insulin to grow and the demand for insulin increases as the pregnancy progresses and the baby grows. Insulin is a hormone that helps to move glucose from the bloodstream into the cells where it is used for energy. During pregnancy, higher levels of hormones can interfere with insulins’ ability to transfer glucose, and this increases blood sugar levels. In response to the increase in blood sugar levels the pancreas increases production of insulin. So, in essence, during pregnancy your body needs to (and usually does) bump up the levels of insulin to keep up with the increase in demand for more insulin – especially in the second and third trimesters.

Many women worry about developing gestational diabetes while pregnant and this is completely understandable. In the UK, gestational diabetes affects 1 in 20 pregnancies which equates to approximately 4% of all pregnancies per year (or approximately 24,000 pregnancies). It’s not clear why some women develop gestational diabetes but cases are on the rise so it’s worth being aware of the symptoms and associated risks.

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What are the symptoms of gestational diabetes?

Confusingly, some of the symptoms of gestational diabetes are similar or the same as pregnancy symptoms. This is why a screening test is offered to those who are more at risk of developing the condition. Symptoms include:

  • A need to pee, often
  • Thirst
  • A dry mouth
  • Tiredness
  • Blurry eyesight
  • Itchiness or thrush

If you’re ever concerned about any symptoms you’re experiencing, always contact your midwife or GP.

What factors increase the risk of developing gestational diabetes?

While anyone can develop gestational diabetes during pregnancy, some of the factors that may increase your risk include:

  • A family history of diabetes – at least one parent or sibling who has had diabetes
  • Being over 40 – the NHS recommends a screening for gestational diabetes for anyone over the age of 40. It is your choice as to whether you accept a screening.
  • Being overweight or obese. The NHS suggests that a BMI over 30 puts you at an increased risk. This is worth challenging if your pregnancy is low risk and complication free and if you are otherwise fit and healthy.
  • If you have had it before in a previous pregnancy and if your baby weighed more than 10lbs (4.5kgs). This can often be seen as the cause of gestational diabetes however it should only be seen as an association to developing the condition.
  • Having a South Asian, Black or African Caribbean or Middle Eastern background.

How is gestational diabetes diagnosed?

During your first booking appointment with your midwife you will be asked a set of questions to determine the risk of you developing gestational diabetes during your pregnancy. Questions will include family history, BMI and other factors that could increase your chances of developing the condition. Some women do develop gestational diabetes who aren’t within the risk groups so whilst the screening is important for identifying women who could be more at risk, it does put some women within a group of being ‘high risk’ even if gestational diabetes isn’t diagnosed.

If you have 1 or more of the risk factors you will be offered a screening test called an Oral Glucose Tolerance Test (OGTT). The test involves having a blood test in the morning after you haven’t had anything to eat for 8-10 hours. After the blood test you will be given a glucose drink and you will then be asked to rest for 2 hours. After your period of resting another blood sample will be taken to test how your body has dealt with the glucose.

After the initial screening test, you will be offered another between weeks 24 and 28 of pregnancy. If you fall within the overarching risk factors you will be offered a screening for the condition.

In an ideal world all women would be offered the screening so that we are all treated equal. Sadly, probably due to resource issues within the NHS a screening is only offered to those who fall within the risk criteria. This is an issue because it puts a small group of women into the category of being ‘high risk’ using overarching impersonalized guidance and therefore disempowering women when it comes to their birth choices. On the flip side of the argument around gestational diabetes and a screening for all – if this happened it could lead to more intervention during labour which interrupts the normal physiological process your body goes through to birth your baby. This can have a myriad of poor outcomes, the most obvious one being a potential impact to the mothers mental health. Birth is a very personal subject and many will have differing view points on what is right or wrong. Ultimately, it is down to you to decide what feels right or wrong for you, your body and your baby.

Complications of gestational diabetes

Most women who are diagnosed with gestational diabetes will go on to have a healthy pregnancy and give birth to a healthy baby. If the condition is left untreated however, it can have poor outcomes of the pregnancy. These include:

  • Your baby could grow to a larger than normal size which could make labour more difficult, painful and be distressing for your baby
  • Your baby could have low blood sugar at birth
  • Your baby could be at risk of being overweight or having type 2 diabetes later in life
  • Other immediate risks include: induction, cesarean section and your baby having jaundice
  • Finally, there is a small chance your baby could die around the time of birth. Working with your healthcare team to keep your blood sugar levels low will help you to keep within your target range and will increase your chances of enjoying a healthy pregnancy.

There is a lot you can to do reduce the risks. Your health care team should be supporting you to:

  • Check your blood sugar levels to ensure they stay within the target range
  • Advice on how to make healthier food choices and enjoy a nutritional diet
  • Types of daily exercise to take
  • How to take medication and insulin – if you need it
  • Talking to you about birth in a way which enables you to make choices for yourself whilst keeping in mind the potential complications that may occur when you have gestational diabetes.

Although the risks may seem scary, it’s important to remember that with proper management, many women have a happy pregnancy and give birth to a perfectly healthy baby.

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How can you reduce your chances of developing gestational diabetes?

It’s not always possible to completely prevent gestational diabetes. However, with a healthy diet and regular exercise you can manage the condition and reduce the associated risks.

You may have heard that it’s a good idea to lose weight before falling pregnant. It’s important to be clear about why this might be advised.

Firstly, for some, losing weight increases your chances of falling pregnant. This is because being overweight is associated with hormonal imbalances and unpredictable menstrual cycle. Whilst this might be true for some, many women who have a higher BMI are perfectly healthy and wouldn’t have some of the complications associated with weight such as an unpredictable menstrual cycle. These assumptions could be classed as ‘body shaming’ and could be deeply upsetting for some women who are labelled ‘overweight’.

The other reason it might be advised that you lose weight before falling pregnant is to reduce your chances of developing gestational diabetes. This is linked to the increased risk of developing the condition if you have a BMI of over 30. Now, as I’ve outlined above – the suggestion that weight might impact pregnancy is true for some but not all women. So instead of body shaming some, we should be encouraging all women to stay fit and healthy when pregnant. Gestational diabetes can affect those with a BMI under 30. Being fit and healthy is key.

If you are already pregnant and want to reduce your chances of developing the condition then it’s advised to eat a healthy diet and take regular exercise. This could include swimming, walking, yoga or even jogging. In terms of what to eat – reducing your intake of sugar is advised. You may hear people saying that ‘you’re eating for two’ but this really isn’t the case.

If you do develop gestational diabetes, remember that you’ve done nothing wrong and that the condition does usually disappear after you give birth. Some women worry that their birth choices may be impacted and that they have to give birth under strict control. This isn’t true at all. When you’re navigating your choices your midwife or healthcare provider should be providing the facts, stats and information for you to make informed choices about your care. They can only ever guide you – no one can ever tell you what you can or cannot do. Even with gestational diabetes, the choice is yours.

In conclusion, being fit and healthy is the absolute best way to reduce your chances of developing gestational diabetes.

Recommended time to give birth when you have gestational diabetes

70% of cases of gestational diabetes are classed as ‘A1 GDM’ by the NHS meaning that this types of GD is controlled by diet and nutrition. Globally, there is no clear guidance on the optimal time for birth in women with A1 GDM. In the US they recommend between 39 and 40+6 weeks. In Canada it’s recommended that birth occurs at 40 weeks. In China they’d ideally like all mothers with A1 GDM to birth by 40-41 weeks. And in the UK? Well, the NHS recommends induction of labour by 41 weeks.

If however, you fall into the group who’s gestational diabetes is managed by medication in the form of metformin or insulin (named A2 GDM by the NHS), the NHS recommends your induction of labour happens before 41 weeks. Globally, there is a general consensus that time of delivery should occur around 39+6 weeks of gestation for those with A2 GDM.

Ultimately, it’s hard to apply such generalized advice to individual cases so it’s always best you discuss your options with your healthcare team. It is always your choice whether you accept induction of labour, cesarean section or any other type of medical intervention. Here are the reasons why it may be recommended that your baby is born earlier:

  • Your baby’s abdomen is larger than it’s head
  • There is a lot of fluid around your baby
  • The levels of insulin are falling rather than rising towards the end of pregnancy

 


Your options for birth if you have gestational diabetes

As you may know, it is your human right to decide how, when and where you birth your baby. For those without complications this can mean waiting for labour to start spontaneously which for most is their preferred option.

For some, especially those with gestational diabetes, a deeper and slightly more complex discussion needs to be had about your birth choices. This is because the default position is likely to be to take what is deemed the safest route for you and your baby. Of course, we want you both to be safe and well however, the advice you may be given could be generalised and not personal to your situation.

The advice on where and how you give birth will depend on the treatment you are receiving for your gestational diabetes and if your blood sugar levels are under control. The treatment you are receiving will either be diet controlled (A1 GDM) or controlled by medications such as metformin or insulin (A2 GDM).

During labour, it may be advised that your insulin levels are monitored regularly. You could be advised to have an insulin drip which will control your blood sugar levels while you are giving birth. This would need to be done on a consultant led unit which might mean that you are asked to lay on a bed – restricting movement. If anything doesn’t feel right for you or is not within your birth plan then you have every right to make necessary adjustments so you can move and still have the drip applied while you give birth.

The same rules apply if you are advised to have continuous monitoring during labour whereby you would have a monitor strapped to your bump. The automatic assumption might be that you will birth on your back but this isn’t the case at all, you can move as much as you like – it is your human right to birth how and where feels best for you.

If you would like a water birth and you’re being asked to birth on a consultant led unit then it may not be possible to have one as there may be no birth pool available. Every Trust is different so discuss your options with your team to find out your options and then make an informed decision that feels right for you. If you feel strongly about birthing in water and want to go against medical advice then you can – no one can tell you what to do. It is up to you to weigh up any associated risks based on your individual circumstances.

If you want to challenge or discuss any aspects of your labour that you’re not comfortable with then it’s best to try and do this sooner rather than later and to have your birth partner advocate for you during labour. Some questions you might want to ask if you are asked to birth on a consultant led unit:

  • Is a wireless monitor an option
  • How can the room be made dark and quiet
  • Further interventions that might occur – what is the knock-on affect of accepting induction of labour for example
  • Your individual blood sugar levels against the national average – can the generalised guidance be adjusted for your individual case if for example your levels are well under control
  • Your baby’s movements
  • Your baby’s growth and size
  • Any other conditions like raised blood pressure

 

The bottom line

 

Gestational diabetes is a really complex subject, from conception to babe in arms – if you are diagnosed with gestational diabetes you can suddenly be presented with a myriad of decisions and discussions with your healthcare team. Put simply – it can feel like a lot!

Know that for most (70%) gestational diabetes can be controlled through diet and nutrition and once you give birth the condition goes away on it’s own. Yes there are associated risks during labour that need to be factored in however one of the greatest risks is the normal physiological process of labour being derailed due to a cascade of medical interventions. Sometimes, this is necessary and sometimes it isn’t. Knowing your options and what the pros and cons are of every medical intervention will help you to make informed choices.

Ultimately, we want you to have a happy, healthy and stress free pregnancy. This can be hard to achieve if you’re also navigating a diagnosis of gestational diabetes. It’s important to keep in mind that with a controlled diet and a healthy lifestyle the vast majority of women do have a happy and healthy pregnancy.

If you’re feeling anxious or worried about anything related to your condition then it’s important to speak up. Your partner, your friends, your family, your midwife – your support network is there to listen, guide and hear you.

 

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