Gestational diabetes and pregnancy

Written by: Dr Bobby Huda
Published:
Edited by: Lisa Heffernan

Pregnancy can be exciting, but also scary at the same time, especially if you’re a woman with diabetes or you develop gestational diabetes throughout your pregnancy. Even though you may be at a greater risk of developing complications during pregnancy, it is entirely possible with good blood sugar control and careful monitoring to have a healthy baby and a successful pregnancy. Endocrinologist Dr Bobby Huda talks about how this can be achieved.

A woman with pre-existing diabetes, whether that be type 1 or type 2 diabetes may experience problems in the earlier part of pregnancy and around the time of conception. A different type of diabetes, that we call “ gestational diabetes ” is a form of diabetes that only develops once the woman is pregnant. This type of diabetes tends to affect the middle and latter parts of pregnancy.

 

What are the symptoms of gestational diabetes?

Symptoms of gestational diabetes can be exactly the same as type 1 or type 2 diabetes, such as:

  • Extreme fatigue
  • Chronic thirst
  • Regularly needing to pass urine, sometimes very clear urine in large amounts
  • Blurred vision
  • Weight loss outside of pregnancy

However, gestational diabetes is normally quite mild and most women won’t experience any symptoms at all. For this reason, it can be difficult to detect, but screening tests are available in the UK and internationally to test for its presence.

The test involves a blood test before and after consuming a glucose drink to compare blood glucose levels before and after. If the level of glucose in the blood is abnormally high after the drink, this helps to convey that there is glucose intolerance and the presence of gestational diabetes.

 

What health risks may I face?

The risks faced will be different for women who already have diabetes and those who have gestational diabetes. Risks are a bit higher for women who already have diabetes, this is because at the beginning of pregnancy, in the first 12 weeks, the baby’s major organs like the heart and brain are being developed. If blood sugars are high at this time, it can cause damage to these vital organs.

High blood sugars can also mean that the baby receives too much glucose and becomes quite big, making labour difficult and leading to an increased chance of needing a caesarean section. There is also a slight chance of any existing kidney or eye conditions worsening during pregnancy.

Women with gestational diabetes will only experience high blood sugars later in the pregnancy after all the major organs have been developed, which puts the baby at less of a risk of complications. However, if blood sugar levels are not balanced early on in the pregnancy, the same complications can ensue.

There is also an increased chance of gestational hypertension, which is raised blood pressure, which may need treatment. A condition called preeclampsia, which is rare, is another possible complication. This is where blood pressure becomes so high that it affects blood vessels and organs and can be quite dangerous.

 

How can I ensure a successful pregnancy?

A successful pregnancy is really about good blood sugar control and stopping any harmful medications that might not be safe during pregnancy. It’s ideal to start planning pregnancy three months in advance, so that blood sugars are under control when pregnancy happens. It’s also important to start folic acid at a high dose.

During pregnancy, the growth of the baby will be monitored very closely, along with blood sugar levels, either using a meter or a glucose sensor. A big part of control involves following a healthy, balanced diet and depending on the type of diabetes, taking a tablet called metformin or insulin injections. The patient should expect to see their endocrinologist two to three times a week throughout the pregnancy, who will work closely with their obstetrician to ensure the pregnancy is successful.

 

If you’d like to know more about diabetes and Dr Bobby Huda, please visit his profile.

By Dr Bobby Huda
Endocrinology, diabetes & metabolism

Dr Bobby Huda is a renowned consultant endocrinologist in London with over 15 years of experience, and currently works as an NHS consultant at St Bartholomew's and the Royal London Hospitals, Barts Health NHS Trust. Having completed his medical training at the University of Liverpool, he went on to general and specialist training at the prestigious University Hospital Aintree, Liverpool, King's College Hospital, and Guy's and St Thomas' Hospitals in London.

At the forefront of his field, he takes a particular clinical interest in type 1 and antenatal diabetes and sits on several regional and national committees. He was a Clinical Lecturer at the world famous diabetes centre at King's College Hospital and gained valuable expertise in antenatal diabetes and insulin pump/glucose sensor therapy. Following successful completion of his PhD, he was awarded a National Institute of Health Research (NIHR) Academic Clinical Lecturer post in Diabetes & Endocrinology at King's College London from 2011 to 2012, further pursuing research interests in obstructive sleep apnoea and inpatient diabetes. More recent research is centred around Gestational Diabetes and the use of Artifical Intelligence in managing gestational diabetes. He is currently co-applicant on two £2 million grants researching these areas. He has recently co-authored the Royal College of Obsterician & Gynaecologists' guidelines on Alternative testing for Gestational diabetes during the Covid-19 pandemic.

Passionate about teaching and research, he currently holds lecturing positions at a number of prestigious establishments including King's College London and Barts and the London Medical School. He has also published over thirty articles in peer-reviewed journals and several book chapters. 

He has considerable clinical expertise in type 1 diabetes, insulin pump/ glucose sensors, MODY diabetes and diabetes in pregnancy. Specifically he has experience with all current insulin pumps, hybrid closed loop systems and real time Continuous Glucose Monitoring/ Flash glucose monitoring. He leads the Barts Health Genetic Diabetes clinic and has significant experience in assessing and managing atypical/MODY diabetes. He has experience in managing women with gestational diabetes, alternative tests to the Glucose Tolerance Test and significant experience in managing women with type 1, type 2, MODY diabetes during pre-conception, pregnancy and the post-partum period. He leads a multi-disciplinary busy diabetes antenatal clinic and works closely with obstetricans, dieticians and opthalmologists to optimise pregnancy care. He also leads the North-East London Sustainability and Transformation Preconception workstream and works closely with fertiliity services within the NHS and private sectors, to promote optimal glucose control during and after assisted conception. He represents North-East London on the London Diabetes Clinical Network groups for Type 1 diabetes, Inpatient diabetes and Diabetes in Pregnancy and sits within a Expert Reference Group for the National Gestational Diabetes Audit. He has previously sat on NICE committees for Diagnostic Assessments of insulin pump technology.

He also consults on inpatient diabetes, diabetes foot problems, genetic forms of diabetes and type 2 diabetes/ insulin resistance. He is currently not consulting on general endocrinology.

His medico-legal work has spanned both defendant and claimant reports and covers all aspects of diabetes including diagnosis of diabetes, diabetes foot ulcers, Charcot's foot, diabetes preconception/pregnancy and inpatient diabetes.

 

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