Gestational diabetes is high blood glucose first recognised during pregnancy. It happens when the body cannot make enough insulin to meet the extra demands of pregnancy. It usually improves after the baby is born, but it increases the chance of gestational diabetes in a future pregnancy and type 2 diabetes later in life.
The condition is important because good blood glucose control reduces the risk of problems for both mother and baby. Management usually involves blood glucose testing, diet advice, physical activity where suitable, closer pregnancy monitoring and, when needed, medicine.
Symptoms
Gestational diabetes often causes no obvious symptoms. When symptoms do occur, they may include increased thirst, passing urine more often, tiredness, blurred vision or a dry mouth. These symptoms can overlap with normal pregnancy changes, so screening is important for people with risk factors.
Risk Factors
Risk is higher in people who have had gestational diabetes before, have a close family history of diabetes, are overweight, have previously had a large baby, or come from an ethnic background with a higher rate of type 2 diabetes.
Risk factors do not mean a person has done something wrong. Pregnancy changes how insulin works, and some people develop high blood glucose despite having no obvious symptoms.
Screening and Diagnosis
In the UK, risk is usually assessed at the first antenatal appointment. People with one or more risk factors should be offered an oral glucose tolerance test, often between 24 and 28 weeks of pregnancy.
The test involves a blood sample after fasting, a glucose drink, and another blood sample after a resting period. If someone has had gestational diabetes before, testing may be offered earlier and then repeated later if the first result is normal.
Management During Pregnancy
Treatment aims to keep blood glucose within the target range advised by the pregnancy diabetes team. A person is usually given a blood glucose testing kit and shown when and how to test.
Dietary changes can help stabilise blood glucose. Advice is usually focused on regular meals, carbohydrate quality and portion size, fibre, protein and avoiding large spikes in glucose. A dietitian may be involved.
Physical activity can lower blood glucose. Walking, swimming and pregnancy-safe exercise may be recommended, depending on the person's health and pregnancy.
If diet and activity do not control blood glucose well enough, medicine may be used. NHS guidance describes metformin tablets and insulin injections as common options. Insulin may be recommended if glucose is very high, if metformin is unsuitable or ineffective, or if there are concerns such as a very large baby or too much amniotic fluid.
Birth and Monitoring
Pregnancy and labour are usually monitored more closely. Timing of birth depends on blood glucose control, growth scans, the mother's health and the baby's health. NHS guidance says birth is often planned around 38 to 40 weeks, with earlier delivery considered if there are concerns.
After birth, glucose levels often return to normal and pregnancy diabetes medicines can usually be stopped, but this should be handled by the care team.
Risks and Long-Term Follow-Up
If gestational diabetes is not well controlled, risks can include a larger baby, birth complications, induction of labour or caesarean section, newborn low blood glucose, pre-eclampsia and premature birth.
People who have had gestational diabetes should usually have a blood test 6 to 13 weeks after birth and then regular checks after that. They may also be offered prevention support to reduce the future risk of type 2 diabetes.
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References
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