A guide to Birth and the Postnatal Period for people with Gestational Diabetes

This information is designed for pregnant people who have received a diagnosis of Gestational Diabetes during their pregnancy. It explains how we routinely manage Gestational Diabetes during the birth of your baby and what happens after the baby is born.

When I attend the hospital to have my baby how will my gestational diabetes be managed?

When you come into the 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 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 as follows:

  • If gestational diabetes has been controlled through Diet or Metformin medication – The midwife will check your blood glucose level every two hours 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.
  • If gestational diabetes has been controlled through Insulin – The midwife will start an intravenous infusion (administered through a cannula in your hand) when active labour commences to keep your blood glucose level stable Your blood glucose level will be checked every hour.

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?

The glucose monitoring kit cannot be reused therefore please put the monitor in your normal household waste (remember to remove the circular battery before doing so and dispose of this safely and separately). 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 the 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 risk of developing Type 2 diabetes in the future. Within five years of having your baby, the risk of developing Type 2 diabetes is approximately 50%.

When your baby is between three and six 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 to 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 make a referral to 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 higher than normal blood glucose levels, he or she does have an increased risk 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 two-three 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 the maternity staff will complete regular observations of your baby (including temperature, heart rate and breathing rate) to ensure 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 in the Postnatal Ward for at least one 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 the 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, 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?

When pregnancy is affected by gestational diabetes, the baby has an increased risk 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:

  • Reduced risk of obesity, diabetes, serious ear and digestive infections, asthma and eczema for your baby.
  • 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 a little 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:

Who can I contact

You can contact the Diabetes Midwives Mon – Fri 08.30-16.30 via any of the following methods:

Phone or text 07855982286