Diabetes team

Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy.

It affects about 20% of women giving birth at Kingston Hospital.

GDM occurs because the body cannot produce enough insulin (a hormone) to keep the blood glucose levels within a normal range. In pregnancy your body can become resistant to insulin due to the hormonal changes. As a result, the blood glucose level becomes higher.

You can find out much more about gestational diabetes from the charity Diabetes UK here, including dietary advice, information about treatments, and videos sharing different women’s experiences of having GDM.

GDM is usually diagnosed by a blood test at about week 28 of the pregnancy. However, you may be tested at 16 weeks if you have had GDM in a previous pregnancy or have glucose in your urine at your booking appointment. Sometimes GDM is also picked up much later on in the pregnancy.

Although anyone can develop GDM there are factors which increase your chances:

• Age (if you are over 40 years old)
• BMI over 30
• Previous GDM
• Family history of type 1 or type 2 diabetes
• Polycystic Ovarian Syndrome
• Previous baby weighing over 4.5kg (10lbs)
• Women from a South Asian, Black or African Caribbean or Middle Eastern background.

An oral Glucose Tolerance Test or OGTT is a screening tool we use to identify GDM. 

You have been invited to have this blood test because you are in a group with a higher chance of developing gestational diabetes.

Please read the following instructions carefully as not doing so could invalidate your test and its results.

The GTT consists of two blood tests, two hours apart. You will be given a time and location for your test.

You must not eat or drink for 12 hours before the first test, except for plain water. This includes sweets, chewing gum and mints. If you eat or drink anything other than plain water, this will invalidate the test.

After the first blood test you will be given a sugary drink and then must sit and rest for 2 hours.

• You must not eat or drink anything except plain water during this time

• You can rest in the waiting room, your car or other quiet place. Please do not walk far.

We will then take your blood again. The maternity support worker will tell you what time to come back for your second blood test.

Please be present in the waiting room ready for your blood test ten minutes before this time. If you are not ready for your blood test at the allotted time, the entire test will need to be cancelled and you will need to attend another day for the full test.

If the test shows you have developed gestational diabetes, you will be contacted by phone within 48 hours.

If the test shows you have not developed gestational diabetes, you will not receive a phone call. Your midwife will have your results for you at your next appointment.

Please note that some women will need more than one OGTT during their pregnancy and you will be advised by your midwife if this is the case for you.

If you would like more information about gestational diabetes or the OGTT, please contact the Diabetes Specialist Midwives by email on khft.diaban@nhs.net

We are here to help support you through the rest of your pregnancy.

It is important to know:

• Anyone can be diagnosed with GDM.
• It is not a reflection on your diet or lifestyle – you have not done anything wrong.
• GDM occurs because the placenta affects the production of insulin (the hormone which helps manage blood sugar levels).
• We are here to support you to make changes in your diet.
• If your readings are in target range, it will make a difference to you and your baby.

We ask that you:

• Join the online information session run by Diabetes Specialist Midwives, if you haven’t already. These take place on Mondays and Thursdays, 08.45 – 10.45.

• Continue to test your sugars 4 times a day until your baby is born.

• Record your readings in the GDM Health app.

• Attend your extra appointments with the diabetes team. These will be added according to our assessment of your health needs. They include:
  • Face to face and/or telephone appointments with our diabetes midwives
  • Extra ultrasound scans at 28 and or 32 weeks, if clinically indicated
  • An ultrasound scan at 36 weeks
  • A 36-week appointment with the Diabetes consultant to discuss birth planning.

You can watch this short video to understand more about GDM and how we monitor it during pregnancy:

How to use your blood glucose monitor - YouTube

The most important thing to remember is this is not a diet to lose weight!

It is important to eat a healthy diet to ensure you and your baby are getting everything you need, but you should think about reducing your intake of some foods that are likely to increase your blood sugar levels. These include sugary foods and large portions of starchy foods.

Here are some of our top tips for meal planning with GDM:

• Do not cut out carbohydrates - you still need carbohydrates in your diet as they are a great source of energy. Do think about choosing different types of carb.
• Choose slow releasing carbohydrates such as wholemeal breads, rice and pasta. instead of white breads or white rice.
• Add as much vegetable and salads as you can to your plate to help balance out the carbohydrate.
• Include proteins and healthy fats such as lean meats, cheese, avocados and eggs.
• Aim for no more than 2 portions of fruit each day – avoid fruit juices
• Choose drinks that do not contain sugar. You can use ‘sugar free’ fizzy & ‘no added sugar’ squashes. 
• Try to avoid puddings, sweets, chocolate, honey and refined sugars.
• Take a short walk after your main meal if possible – it will help lower your blood sugar

If you are hungry between meals, you can have a snack. Here are some suggestions for suitable choices:

• one small pot ‘diet’ yogurt (125g)
• Small portion Greek yogurt and a few berries, nuts or seeds 
• one portion fruit
• Unsalted nuts (small handful – 20-30g)
• Avocado
• Olives
• Hummus, cheese or peanut butter with veg/salad sticks or 1-2 oatcakes or 1-2 crackers.

You can find more ideas here:

• Gestational diabetes diet | What can I eat | Diabetes UK
• Recipe finder - Enjoy Food | Diabetes UK
   

Activity helps to manage your gestational diabetes. It increases the amount of glucose (sugar) used by your muscles for energy, which helps to lower your blood sugar levels. Being active also helps the body use insulin more efficiently.

What should I aim for?  

Try to take regular physical activity that is appropriate for you, such as: 

• Going for regular walks after lunch or dinner. Being active for 15-20 minutes within 30 minutes of a meal will help get your post-meal sugar level in the target range you have been recommended.  

• Pregnancy yoga – you can look for videos to follow online, or go to a class 

• Swimming or water aerobics

You can find more information on exercise here.

Women with GDM are often advised to have their babies earlier than women without GDM. This is because diabetes can affect the placenta, meaning it may be safer for your baby to be born slightly sooner.

Every woman’s pregnancy is different. Your individual birth plan will be made with you at your 36-week appointment. 

We recommend everyone with GDM attends the Induction of Labour online workshop before their 36-week appointment. This will enable you to have a personalised and informed conversation with the doctor.

Watch Natalie’s story, about her positive experience of induction following a diagnosis of GDM.

Many women with GDM give birth in the midwife-led Birth Centre, whilst others choose or are recommended to give birth in the Delivery Suite.

If your labour is induced, you may still have the option to give birth in the Birth Centre. Speak to your doctor at your 36-week appointment.

GDM usually goes away after you’ve had your baby. 

We recommend you have a blood test 13 weeks after your baby is born to test your blood glucose level. You will be given a letter to take to your GP about this.

If you needed tablets or insulin treatment for your diabetes during your pregnancy, this will be stopped as soon as your baby is born.

Gestational diabetes is likely to occur again if you have another baby. Therefore, in your next pregnancy you will be recommended to have a Glucose Tolerance Test at 16 weeks. If it is negative, it will be repeated at 28 weeks.

Women who have had gestational diabetes have an increased risk of developing Type 2 diabetes during their lifetime. 

• To help reduce your risk of developing type 2 diabetes later in life it is important to continue eating a healthy diet, keep to a healthy weight and keep physically active. 
• The recommendation for physical activity is to aim for a minimum of 30 minutes a day, 5 days a week, taking exercise that gets you comfortably out of breath. This could be brisk walking, gardening, cycling, swimming, dancing or any other activity you enjoy.

It is recommended by NICE (the National Institute for Health and Care Excellence) that you have a blood glucose test each year – this is arranged through your GP.
 

Most women with gestational diabetes have a healthy pregnancy and a healthy baby. If diabetes is not treated it can cause complications, including the baby growing larger than normal. You can read more information about potential complications here.

Having gestational diabetes does not cause your baby to be born with diabetes.

Your baby may develop low blood sugars for a short period (approximately 24 hours) after birth. This is known as hypoglycaemia. 

We will check your baby for signs of hypoglycaemia during the first 24 hours of life. Staff will test your baby’s blood sugar levels and carry out regular observations of your baby’s temperature, heart rate, breathing rate and general well-being.

You can help reduce the chance of your baby developing hypoglycaemia by feeding them in the first hour after birth, keeping them warm, and continuing to give them regular feeds. The midwives and maternity support workers will support you with this.

If you’re planning to breastfeed your baby, we recommend you attend an infant feeding class. You can book our online infant feeding class here.

We can also provide a kit to help you hand express colostrum (the first milk that your breasts produce for your baby) from 36 weeks onwards. You can give your newborn baby extra colostrum that you have hand-expressed to help maintain their blood sugar levels. Read more about hand expressing colostrum here.

We have a fantastic diabetes team here at Kingston hospital ready to support you through your pregnancy.

Email: khft.diaban@nhs.net
Mobile (call/text/Whatsapp): 07385 949047
Or request a callback on the app. This is the best way to contact us.

Further advice and information

Gestational diabetes | Causes and symptoms | Diabetes UK
Gestational diabetes - NHS (www.nhs.uk)

Telephone Numbers for sharps bin collections:

Kingston: 020 7188 9399
Richmond and Twickenham: 020 7188 9399
Wandsworth: 020 8871 8558
Elmbridge: 01372 474775
Merton: 020 8545 3022