Gestational Diabetes

This information is for you if you want to know about Gestational Diabetes or have recently been diagnosed with Gestational Diabetes.

What is Gestational Diabetes?

Gestational Diabetes is a type of diabetes which occurs during pregnancy.  The exact cause is not known but it is thought the body cannot produce enough insulin to meet the extra needs of pregnancy.

Insulin helps us turn glucose into energy.

We get glucose from the carbohydrates foods in our diet such as:

• Starchy foods e.g. bread, rice, pasta, potatoes, cereals
• Sugar and other sweet foods e.g. biscuits, cakes, sweets

A lack of insulin can result in high blood glucose levels.

What are the risk factors?

• Previous gestational diabetes
• Previous larger baby over 4.5Kg
• Body Mass Index (BMI) over 30Kg/m²
• If you have an immediate family member with diabetes (parent, brother or sister)
• If you are of South Asian, Chinese, African-Caribbean or Middle Eastern origin
• Previous stillbirth
• Polycystic Ovarian Syndrome (PCOS)
• Large baby or extra fluid around the baby (diagnosed on scan)
• Women who take antipsychotic medication- Clozapine/Olanzapine/Quetiapine

How will it affect me and my baby?

Most women who develop gestational diabetes have healthy pregnancies and healthy babies but occasionally gestational diabetes can cause serious problems, especially if it is not recognised or treated.

If your blood glucose levels are high, the chances of you having an induced labour or a caesarean birth are increased.

The risks to your baby are:

• Being bigger than average
• Shoulder dystocia(where your baby’s shoulder gets stuck during birth)
• Stillbirth or the baby dying at or around the time of birth. This is uncommon.
• Needing additional care once they have been born, possibly in a neonatal unit
• Being at greater risk of developing obesity and developing type 2 diabetes in later life.

Controlling your levels of blood glucose during pregnancy and labour reduces the chances of these complications for you and your baby.

If your blood glucose levels are not well controlled during pregnancy it can cause the baby to grow larger than normal, which in turn can make delivery difficult.

Gestational diabetes can also increase the risk of stillbirth, can raise blood pressure during the pregnancy (pre-eclampsia) and can cause preterm (early) labour.

After the birth, if your blood glucose has not been well controlled there may be problems for your baby immediately after delivery, such as:

• Needing help to breathe
• Having very low blood glucose levels
• Developing jaundice

These risks can be significantly reduced with the support of your health care team.

What can I do whilst pregnant?

You can help yourself by monitoring your blood glucose levels, taking regular exercise and implementing a healthy diet.

Blood glucose monitoring

You will be given a blood glucose monitoring meter which the Diabetes team will show you how to check your blood glucose and be given a diary to record the results.  You will be asked to check your blood glucose levels post meals.

The blood glucose levels should ideally be:

Fasting (when you get up in the morning) and pre-meal:          4.0-5.3 mmol/L

1 hour after a meal:                                                               Less than 7.8 mmol/L

2 hours after a meal:                                                             Less than 6.4 mmol/L

Exercise

The most important treatment for gestational diabetes is a healthy eating plan and exercising regularly. Walking for 30 minutes after a meal can help with controlling your blood glucose levels. Gestational diabetes usually improves with these changes. You should have an opportunity to talk to a healthcare professional about choosing foods that will help to keep your blood glucose at a healthy and stable level.

Try to increase your levels of activity through more walking or swimming.  Check with your doctor first if you have any other pregnancy complications.

Weight

It is a myth that you are eating for two.  Your calorie requirements increase very little.  If additional energy is required it is usually only about 200 extra calories a day during the last 3 months (1 whole-wheat pitta with 2 tablespoons of hummus).

The average weight gain during pregnancy is just under 2 stones (12kg).  The amount of weight you are advised to gain depends upon your pre-pregnancy weight.

Principles of healthy eating with Gestational Diabetes

The diet recommended for women with Gestational Diabetes is a healthy diet similar to that recommended for the general population with more emphasis on low glycaemic index carbohydrates.

Carbohydrate is the main type of food which affects your blood glucose levels.

During digestion, carbohydrate foods are broken down into glucose, which is absorbed into the blood stream causing a rise in your blood glucose level.

Blood glucose is the body’s main source of fuel and requires insulin to move it from the blood stream into the body tissues where it is used for energy.

Main Dietary Principles for Gestational Diabetes

1. Include starchy carbohydrate foods at every meal to help regulate blood glucose levels. However the more carbohydrate foods you eat the higher your blood glucose levels will go.  It is recommended that you consume a diet that includes foods that have a low glycaemic  These types of foods allow glucose to be absorbed at a much slower rate which can stop the peak in blood glucose levels after meals.  However it is important to still consider portion sizes.  The following table shows foods having a low glycaemic index:

2. Reduce your sugar intake

3. Carbohydrate free Snacks

• Mixed salad vegetables
• Celery sticks with small amount peanut butter/ ¼ pot Tzatziki dip / ¼ pot guacamole
• 1 avocado
• Olives
• Poached / boiled / scrambled (no milk) eggs
• 1 small omelette with mushroom / ham / pepper
• Chicken strips/wings/drumsticks
• Prawns or seafood
• Tinned salmon / sardines / tuna / mackerel
• Ham/turkey/roast beef/salmon slices/pork /lamb
• Kebab skewers with roast vegetables (courgette/onion/pepper – not potato)
• Small portion of tofu
• 50g Walnuts / Brazils / Pecans / Macadamias / Coconut flakes
• 30g Cashews / Peanuts / Pistachios / Almonds/Sesame seeds
• 20g pumpkin seeds / sunflower seeds / mixed seeds
• Unsweetened coconut flakes
• Shiratake noodles (Konnyaku) from oriental supermarkets or’ Zero Noodles’ from health food shops
• Pepperoni sticks
• Sausages/frankfurters
• Sugar-free jelly
• No added sugar ice pops
• Cocoa hot drink – 1 level tablespoon unsweetened cocoa powder made with hot water and cream

Low Carbohydrate snacks

• Small pot of diet yogurt (<15g carbohydrate) or bowl of Greek yogurt (200-250g pot)
• Fruit – e.g. 1 medium apple/1 small banana/2 small fruits e.g. plums, kiwis or 150g berries +/- wedge of cheese/nuts
• 1-2 Oatcakes/Ryvita/1 slice wholegrain bread with hummus/peanut butter/cottage cheese/mashed avocado/mashed sardines
• Sachet of cup a soup (<15g carbohydrate)/homemade soup
• 1 plain biscuit e.g. Digestive/Hobnob
• Packet of wotsits/french fries/quavers
• 200ml glass of semi-skimmed milk
• 30g plain popcorn

4. Try to eat lean protein foods such as chicken, lean meat, eggs and fish. Try to eat two portions of fish per week, one portion being an oily fish. One portion is roughly 100g (4oz).  Many of the oily fish can be bought fresh or tinned.  The following are examples of types of oily fish:

•           Mackerel
•           Kippers
•           Salmon
•           Pilchards
•           Tuna (fresh/frozen, not tinned)

You should avoid shark, marlin and swordfish.  These types of fish contain high levels of mercury, which can affect your baby’s developing nervous system.

5. Aim for 5 portions of fruit and vegetables daily, spread out fruit during the day, a portion at a time – a portion is the size you can fit in the palm of your hand. Aim to bulk your diet in more vegetables than fruit.
6. Include milk and dairy foods. These are an important source of calcium aim to eat 3 portions a day. (1 yoghurt, 1/3 pint milk, 30g cheese, 1 bowl milk pudding /custard). Low fat versions have the same amount of calcium.
7. Cut down on salt. Use less in cooking and eat less salty foods for overall good health.
8. Avoid special diabetic products, diabetic biscuits and chocolate. They contain the same amount of fat and are not significantly lower in calories than their non-diabetic equivalents. They may also be sweetened with a substance called ‘Sorbitol’ which may cause diarrhoea.
9. Alcohol. Drinking too much alcohol can harm your baby. You should drink as little as possible and ideally stop drinking altogether until after the baby is born.

If dietary measures are not sufficient to control your blood glucose at normal levels, the diabetes team may recommend that you are treated with tablets called Metformin. Some women may need insulin injections as well.

Do you suffer with nausea?

It may be helped by:-

•  Eating dry biscuits or dry toast in the morning
•  Avoiding fried and spicy foods
•  Eating regular meals with snacks in between

Do you suffer with heartburn?

Heartburn can become a problem as pregnancy advances.  To avoid this:

• Chew food thoroughly and do not lie down after eating
• Avoid foods that are hard to digest such as spicy, pickled and fried foods
• Change your daily meal pattern – avoid large meals – try 6 smaller meal a day rather than 3 large. Sleep in a more upright position
• Gaviscon® liquid may help – ask your doctor about this 

What happens after delivery?

You will be given information before you go home after you have had your baby about follow up, screening for diabetes, and future risks.