This information leaflet has been produced by Gateshead Health NHS Foundation Trust Maternity Unit to provide information to pregnant people who have received a diagnosis of Gestational Diabetes. It explains how we routinely manage Gestational Diabetes during the birth of your baby and what happens after the baby is born.
How will gestational diabetes be managed when I attend hospital to have my baby?
When you come into hospital to have your baby please bring all of your diabetes testing equipment (and any medication that has been prescribed during your pregnancy).
For women having an Induction of or Spontaneous Labour:
Please continue to test your blood glucose levels as normal and take any prescribed medication UP UNTIL the point of active labour (this is normally the point when your waters are broken or you are experiencing regular contractions).
After this time, the midwife looking after you will take over the management of your diabetes.
The midwife will check your blood glucose level every hour during labour to make sure it remains between 4-8mmol/mol. If your blood glucose becomes lower or higher than this, the midwife may start an intravenous infusion (administered through a cannula in your hand) to keep the blood glucose level stable.
For women having an Elective Caesarean Section:
Please continue with any prescribed diabetes medication UP UNTIL the night before the surgery. You will be asked to fast (have nothing to eat) from midnight the night before your planned caesarean section.
If you take Humulin I (long-acting insulin) your FINAL dose should be given before bedtime as normal. No further insulin should be given after this time.
What happens after the baby is born?
For the vast majority of women, gestational diabetes resolves soon after the birth of the baby. Therefore, please stop taking any medication that you have been prescribed during pregnancy (Metformin and/or Insulin). After you have been discharged from the hospital, you can also stop testing your blood glucose levels.
During your stay in the postnatal ward after the birth, the staff will ask you to monitor and record your blood glucose level before and after meals for up to 24 hours to ensure there is no sign of ongoing diabetes. If your blood glucose levels remain very high (this is unlikely), we will arrange for you to be seen by the diabetes specialist team before you go home.
What should I do with my diabetes testing equipment and medication?
If you have a Contour Plus (blue) blood glucose monitor, please dispose of it in your normal household waste (remember to remove the circular battery before doing so and dispose of this safely and separately).
If you have a Wireless Jazz (black) blood glucose monitor, please return the monitor to the manufacturer (after removing the circular batteries) using the pre-paid envelope included in your kit. Alternatively, you can return the monitor to QE Maternity Reception or to QE Women’s Health Clinic reception.
Carefully tip any spare needles and testing strips into your yellow sharps box and press down firmly on the lid (this will securely lock the box). Please leave the box at the hospital for disposal or, if you forget, please give it to your Community Midwife or take it to your registered GP.
If you have spare Metformin tablets and/or insulin please give them to a member of maternity staff or return them to any pharmacy for safe disposal. Any leftover insulin needles can be placed in your yellow sharps box.
What is my future risk of diabetes?
All women who have experienced Gestational Diabetes during their pregnancy have an increased chance of developing Type 2 diabetes in the future. Within 5 years of having your baby, the risk of developing Type 2 diabetes is approximately 50%.
When your baby is between 3 and 6 months old, we recommend having a blood test at your GP surgery to make sure your blood glucose levels have returned to normal. The blood test is called an HbA1c and it indicates your average blood glucose levels over the previous 12 weeks. We will send you a letter reminding you to book this appointment.
Due to the lifelong increased risk of Type 2 diabetes, we recommend that you have this blood test repeated every year. You will need to contact your GP surgery to book this appointment.
What are the symptoms of Type 2 diabetes?
As Type 2 diabetes develops, some commonly reported symptoms are:
- TIREDNESS – significant and constant exhaustion/weakness.
- TOILET – frequently needing to pass large volumes of urine.
- THIRST – drinking lots of water but still feeling thirsty.
If you experience any of these symptoms please book an appointment with your GP as soon as possible.
It is still very important to have your annual HbA1c blood test even if you feel well as – in its early stages – Type 2 diabetes may not cause any noticeable symptoms.
Is there anything I can do to reduce my risk of developing Type 2 diabetes in the future?
Yes! By continuing to follow a diet that is well-balanced and low in sugar, as well as trying to keep as active as possible, you can significantly reduce your risk of developing Type 2 diabetes.
Anyone affected by Gestational Diabetes is eligible for referral into the Diabetes Prevention Programme. This is a series of NHS-approved, group-based education sessions that can be delivered either face to face or remotely. As long as your postnatal HbA1c blood test is below 48 mmol/mol, your GP or practice nurse can make a referral into this programme for you. A separate leaflet is available on the Badger Notes app if you would like more information about the Diabetes Prevention Programme.
Can gestational diabetes return in a future pregnancy?
Gestational diabetes tends to reoccur in future pregnancies. If you choose to have another baby, please tell your Community Midwife that you have had gestational diabetes previously and she will make a note of this on your maternity record.
Once you have had your dating scan (between 12 and 14 weeks), we will recommend that you have a test for gestational diabetes as soon as possible so that we can potentially diagnose and treat it at an earlier stage in your pregnancy if it does return.
Will gestational diabetes affect my baby?
Your baby will NOT be born with diabetes. However, as the baby may have been exposed to hiYour baby will NOT be born with diabetes. However, as the baby may have been exposed to higher than normal blood glucose levels, he or she does have an increased chance of developing a low blood glucose level following the birth. This is because the baby may have produced extra insulin during pregnancy and will therefore process the glucose in his or her milk more quickly than normal. In order to reduce the risk of this happening, the midwife looking after you will support you to:
- Initiate skin to skin contact with your baby following the birth, which helps the baby to regulate their temperature and blood glucose level.
- Offer your baby a feed (breast or bottle) within the first hour of birth whilst having skin to skin contact.
- Continue to feed your baby (breast or bottle) whenever the baby is showing hunger cues and, at a minimum, every 2-3 hours.
We will also offer to check your baby’s blood glucose level, via a simple heel-prick test, prior to the baby’s second feed and third feed, to ensure that it is within normal range. This test is carried out at your bedside.
For 12 hours following the birth, a member of maternity staff will complete regular observations of your baby (including temperature, heart rate and breathing rate) to ensure that that he/she is not showing any signs of hypoglycaemia (low blood glucose). Again, these observations are carried out at your bedside. In order to complete these extra observations, you will need to stay on the Postnatal Ward for at least 1 night following the birth. If there are additional concerns identified during this time, a longer stay may be required.
If your baby’s blood glucose level is low, or we have any concerns about your baby’s observations, we will ask a specialist nurse or doctor to check your baby. In rare cases, some babies require extra monitoring and support in our Special Care Baby Unit (SCBU), which is located just beside the Labour Ward. You and your designated birthing partner can visit the baby at any time, 24 hours a day.
Are there any future risks for my baby?
WheWhen a pregnancy is affected by gestational diabetes, the baby has an increased chance of developing childhood obesity and diabetes in the future. One of the most effective ways to reduce these risks is to breastfeed your baby. Breastfeeding brings many health benefits to both you and your baby. These include:
- A reduced risk of obesity, diabetes, serious ear and digestive infections, asthma and eczema for your baby.
- A reduced risk of diabetes, heart disease, osteoporosis (weak bones), ovarian and breast cancer for you.
From 36 weeks of pregnancy we encourage any woman with gestational diabetes to start hand-expressing and collecting colostrum. Colostrum is the first milk that your breasts produce and you may notice small amounts leaking from your nipples during pregnancy. It is clear to yellow in colour, and packed with energy and protective factors for your baby. Colostrum can be given to your baby following birth whilst you are both learning how to breastfeed. If the baby’s blood glucose level is low, giving expressed colostrum often works very effectively to improve it.
We will provide additional instructions and equipment for you to start hand-expressing some colostrum if you feel comfortable to do so.
Where can I find more information?
All of the following web links contain up-to-date, evidence-based information:
- Diabetes UK – for more information about diabetes care during and after birth
- Diabetes Prevention Programme – for information and support about how to prevent the development of Type 2 diabetes
- Active Pregnancy Foundation – for ideas about how to keep active following birth
Who can I contact
You can contact the Diabetes Midwives via any of the following methods:
Monday – Friday
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