gestational diabetes
Health

How to manage gestational diabetes

Find out how to manage gestational diabetes and reduce your risk of developing the condition by following expert advice from consultant dietitian Sarah Keogh.

Gestational Diabetes, also known as pregnancy diabetes, is diabetes that only appears during pregnancy. Gestational diabetes affects about 12% of pregnant women in Ireland and means that many women have to follow a special diet or use insulin while they are pregnant.

Diabetes needs to be carefully managed during pregnancy as it can lead to problems both for mum and baby if it is not looked after. We look at why blood glucose levels are important, some of the problems they can cause and what you can do to avoid gestational diabetes and how you can manage it if it does turn up for you.

Why is gestational diabetes so common?

We hear a lot more about pregnancy diabetes these days because in 2010 the HSE changed the criteria for screening pregnant women. They started to check more women for diabetes and once this happened, the numbers of women found to have gestational diabetes doubled. Screening for gestational diabetes takes place between 26 and 28 weeks.

You will be screened if you are obese (a BMI greater than 30), aged over 40, had diabetes in a previous pregnancy or have polycystic ovary syndrome. As obesity becomes a bigger problem in Ireland, the numbers of women with gestational diabetes has also increased.

What is gestational diabetes?

Diabetes is diagnosed when someone has too much glucose (sometimes called ‘blood sugar’) in their blood. Our bodies make a hormone called insulin. Insulin’s job is to help to keep blood glucose at healthy levels. During pregnancy, insulin has to work harder to control blood glucose levels. For most women this is not a problem, but for some women, the insulin can’t cope and blood glucose levels go up.

Why do high blood glucose levels matter?

High blood glucose levels during pregnancy can cause problems both for mum and for baby. Women with gestational diabetes are more likely to have high blood pressure during pregnancy, they are also more likely to have a premature baby or to have a Caesarean-section.

Glucose in your blood also passes through the placenta and reaches your baby. With gestational diabetes, this means that babies can get too much sugar and this causes them to grow more than they should. Women with gestational diabetes that is not treated can have babies that are much bigger and this can cause problems when it comes to giving birth.

Babies whose mothers had untreated gestational diabetes are also more likely to need special care after they were born, to be born with very low blood glucose levels and to have more obesity and diabetes in later life. However, if you look after your diabetes, these problems are much, much less likely.

Why do some women develop gestational diabetes?

There are certain things that make it more likely that you will get gestational diabetes and the biggest factor is weight. Being older, having a family history of type 2 diabetes or having PCOS will also increase your chances.

How can I manage gestational diabetes?

Diet is the main treatment for gestational diabetes. Even if you eventually need to use insulin, you will still need to look after what you eat. It is important that you see a qualified dietitian who can help you to manage your diabetes. Ideally, you need to see a dietitian within seven days of being diagnosed so that you can get blood glucose levels under control straightaway.

The key things to do are:

  • Cut out unnecessary sugar. This means that you cut out sugary foods like soft drinks, sweets, biscuits, chocolate etc. However, you don’t need to cut out healthy foods that have a little sugar like fruit or yoghurt.
  • Eat smaller portions of carb foods like bread, rice, pasta and potatoes. Although these foods do not have any sugar, the body makes blood glucose from them. Do not cut them out – it is not good to have a low blood sugar either! Your dietitian will be able to work out the correct portion sizes for your weight and pregnancy.
  • Follow a low glycaemic index diet. Low GI foods cause a smaller rise in blood glucose when you eat them compared to high GI foods. Following low GI advice has also been shown to reduce the overall amount of weight you gain during pregnancy.
  • Eat a sensible amount of protein foods. This helps to make sure your baby is getting everything he needs but also helps to control blood glucose levels.
  • Exercise. Walking, swimming or doing any exercise that is safe and comfortable for you will help your insulin to work a lot better. This means that your blood glucose levels will be healthier and it is one way to help avoid going on to insulin.

Will I need insulin?

For some women, diet alone is not enough to get blood glucose to the right level and you may need to take insulin. Your doctor will advise you on when and how much to take and your dietitian will help you to adjust your food as needed.

Gestational diabetes and Type 2 Diabetes

Women who have gestational diabetes are much more likely to develop Type 2 diabetes later on. This is why it is a great idea to stay on the healthy eating plan that you had during pregnancy. Keeping weight at healthy levels, exercising and following a low GI diet can help prevent you from going on to get Type 2 diabetes. You’ll look great, too!

How can I avoid gestational diabetes?

  • The best place to start is before you become pregnant. If you are overweight, start to lose weight. Being overweight is the biggest risk factor for developing gestational diabetes. Any weight loss will help, even a few pounds.
  • Start to cut back on any sugary foods you eat. Foods like fruit and yoghurt are good to eat, but it is a great idea to start reducing or cutting out soft drinks, sweets, chocolate and desserts. You don’t need to ban them but keep them to once or twice a week at most.
  • Exercise – especially any exercise that builds some muscle. The more muscle you have, the better your insulin will work and this is a great way to avoid gestational diabetes. Try pilates or yoga, brisk (really brisk) walking, going to the gym and learning to use weights, kettle bell classes – really, do anything that will give shape to your muscle.
  • Follow a low glycaemic index diet. A low GI diet also helps to get your insulin working. Talk to your dietitian for advice on losing weight without cutting the key nutrients you will need for pregnancy.

More like this:

Keeping fit through pregnancy
Overweight and pregnant
Eating for two

Ask Tracey

Midwife Tracey Donegan answers your questions about pregnancy and birth

Q When should I have my first pregnancy scan? And how many scans should I get throughout my pregnancy?

A
Your first scan is known as your dating scan and is routine in all hospitals. Most mums will have this scan at their booking visit, which can be anywhere between 12-18 weeks. The earlier the scan the more accurate it will be. If you have experienced recurrent miscarriages some hospitals will scan you earlier. Contact your antenatal clinic for more information. In Ireland, most women will have two scans in a healthy pregnancy – a dating scan and an anomaly scan at around 20 weeks. However, some units provide a dating scan only. Private scans are also available in most cities and many parents use these services for additional reassurance and to find out the sex of their baby.

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ASK LUCY

Q My son is 18 months old and has just started saying his first words. It is an extremely exciting time in our house and my husband and I are eager to encourage his speaking as much possible. What advice would you give us on how we can foster this without bombarding and confusing him?

AThere is nothing better than hearing your baby begin to talk. All the hard work you have put in over the last two years is coming back tenfold.
Toddlers will vary significantly with ability and speed of which they talk however a guide would be about 50 words by 2 years of age. The most important thing to watch for is that your baby/toddler is cooing and babbling and begins to string sounds together like “Mama/Dada” They should have a wide range of speech sounds and like to imitate you and things they hear.
There are many ways that you can promote Speech and Language development at home:
1. Slowing down your own speech and taking time over conversations with your little one. Every day is a new experience when you are 18 months, nappy changes, bath time, baking a cake brings endless opportunity for you to interact and offer new words for them to hear and repeat. Make eye contact, smile and use exaggerated tones to keep things interesting and fun for your tot.
2. Review the toys that you have on offer to your tot and ensure that they give plenty of open ended play opportunities. Role play is a wonderful way to allow children to take the lead. Kitchens with lots of plates, cups and pots. Fill the pots with dry pasta and allow your child to cook and serve you. Playdoh, painting, gardening and sandpits are also great for allowing your child to take the lead and babble about what they are doing. Read plenty of books together and point and allow them time to answer any questions that you ask.
3. Limit screen time. Overuse of televisions and iPads do not give your child opportunity to interact in a two way manner.
4. Ask your child lots of open ended questions “What’s that?” “Where are we?” Point at things they know the answer to for boosting confidence (Car/ Car, etc.) When they don’t know the answer, explain it to them. Limit baby talk and speak clearly with good pronunciation, remember you are the teacher and they will copy you.
If you are concerned about your child’s speech and language development, be sure to speak with your GP or developmental Health Nurse. They are very skilled at understanding the difference between speech delays and spotting something that may require professional attention.
Enjoy watching their little brains absorb the world around them and listen to what they have to say. It won’t be too long before they won’t stop talking to you, asking “Why Mummy/ Daddy?” every 5 minutes….