Pregnancy and diabetes - Gestational (GDM), Type 1 or Type 2 diabetes

There are different forms of diabetes that affect some women during pregnancy: Type 1, Type 2 and Gestational diabetes (GDM).

Having diabetes in your pregnancy means that you need to have a few extra visits to the hospital clinics and the Illawarra Shoalhaven Diabetes Services to manage your blood glucose levels and look after baby as they grow.

Type 1 and Type 2 Diabetes  are forms of diabetes that you may already know you have.  You may already be seeing an endocrinologist and they can continue to be involved in your care.

Gestational Diabetes Mellitus (GDM)  is a form of diabetes that affects some women during pregnancy and usually goes away after the baby is born.

Sometimes GDM can be controlled by your diet and sometimes you will need medication such as insulin to help you control your blood sugar/glucose levels.

It is diagnosed when higher than normal blood glucose levels first appear during pregnancy.

The National Diabetes Services Scheme (NDSS) has some great information about diabetes and it is also available in different languages:

Am I at risk for developing GDM?

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You will have a blood test during your pregnancy to check whether you have GDM.

The test is called a GTT (Glucose Tolerance Test). You must fast (have no breakfast) for this test. You will have a fasting blood glucose taken and after a sweet drink your blood glucose levels will be checked at 1 hour and 2 hours.

If you are in the following categories, you will be tested early in your pregnancy, otherwise your test will be at about 28weeks gestation of pregnancy.

Risk factors:

  • Previous hyperglycaemia (high blood glucose levels) in pregnancy
  • Previously elevated blood glucose level
  • Maternal age ≥40 years
  • Ethnicity: Asian, Indian subcontinent, Aboriginal, Torres Strait Islander, Pacific Islander, Maori, Middle Eastern, non-white African
  • Family history diabetes (1st degree relative with diabetes or a sister with hyperglycaemia in pregnancy)
  • Pre-pregnancy BMI > 30 kg/m2
  • Previous macrosomia (baby with birth weight > 4500 g or > 90th centile)
  • Polycystic ovarian syndrome
  • Medications: corticosteroids, antipsychotics 

For more information, click here to access the Diabetes Australia website

How is diabetes in pregnancy diagnosed?

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All women are screened for diabetes in their pregnancy

If you have a high risk for diabetes in pregnancy, e.g. you have previously had GDM, you will have a blood test early in your pregnancy.

If that test is negative, you will be screened again with all other pregnant women with an oral glucose tolerance test (GTT) between 24 and 28 weeks of pregnancy

If you have been diagnosed, you will need to monitor your blood glucose levels and diet, and may also require medication such as insulin.

The Illawarra Shoalhaven Diabetes Service will talk to you about how best to manage your diabetes such as healthy eating, staying physically active and checking your blood glucose levels.

What happens if I have GDM?

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Your GP or the hospital will refer you to the Illawarra Shoalhaven Diabetes Services if you have been diagnosed with GDM.

The Illawarra Shoalhaven Diabetes Service will talk to you about how best to manage your diabetes such as healthy eating, staying physically active and checking your blood glucose levels.

Keeping your blood glucose levels stable looks after the health of both you and your baby.

You will be given a book to record your blood glucose levels (BGL's). You should contact the diabetes educators if you have 3 or more elevated BGL's  in a week.

The diabetes team will look at your BGL's throughout your pregnancy. Routine appointments (a combination of phone, email and face-to-face) will be made to review your GDM until your baby is born.

Phone the Illawarra Shoalhaven Diabetes Service on 1300 308 969 to book your appointment

Illawarra Shoalhaven Diabetes Service website

Birth 

While you are in labour a Midwife will check your BGL until you have your baby.

If you are booked for an elective caesarean section, a Midwife will check your BGL before you go to the operating theatre.

 

Baby's BGL

You and your baby will be transferred to the Maternity ward together with a minimum 24-hour stay

Baby's BGL's will be checked 30 minutes after their very first feed, or 1 hour from birth (whichever comes first)

Midwives then check baby's BGLs before the next 3 feeds ( aiming for at least 2.6mmol/L)

If baby's BGL's are low, your baby may be transferred to the Neonatal or Special Care Unit to be seen by the paediatrician. 

What happens to baby after they are born when I have diabetes?

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When your baby is first born their blood glucose levels (BGL) will be checked regularly. At birth, their BGL will be very much the same as the mother, but within the first hour the level starts to drop

Baby’s BGL's will be monitored from a prick on the baby’s heel and using a similar machine to the one you have used during pregnancy. Our aim is to keep the baby’s blood glucose from dropping below 2.6mmol/L.

You and your baby will be in the Maternity ward together for at least 24-hours. Baby's BGL's will be checked 30 minutes after their very first feed, or 1 hour from birth (whichever comes first) and then before the next 3 feeds.

If baby's BGL's are low, your baby may be transferred to the Neonatal or Special Care Unit to be seen by the paediatrician.

Some ways to keep baby's BGL stable:

  • Immediate skin to skin with the mother, for at least an hour, keeping the baby warm 
  • Having their first breast feed within the first hour (ideally within 30 minutes)
  • Giving the baby some extra colostrum (the first, immune protecting breast milk) can help if they are not ready to feed
  • Feed your baby at least every 3 hours, more frequently if BGL's are low

More information about skin to skin, hand expressing colostrum while you are still pregnant (antenatal expressing) and general breastfeeding information for before and after your baby comes is available on the FEEDING YOUR BABY pages here

GDM- What happens to me after baby is born?

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GDM

Once the baby is born most women can go back to a more normal life, no more blood sugar levels! Your doctor will advise you when to stop testing your BGL's.

More formal blood glucose testing may be done some weeks after the baby is born to make sure your diabetes was just caused by your pregnancy

Women who have had GDM have a higher risk of developing type 2 diabetes in the next 5-10 years.

Your baby also has a higher risk of developing GDM (if they are a girl) and Type 2 diabetes later in life. You can reduce this risk by breastfeeding:

  • Research is showing that women who breastfeed their babies are less likely to develop Type 2 diabetes later in life
  • Breastfeeding also has a protective effect for babies developing diabetes later in life (including Type 1 diabetes).

We may suggest you express your colostrum in the last few weeks of pregnancy to feed to your baby when they are born to help reduce these risks (and for the many other benefits colostrum has for your baby) - see Hand Expressing below or click on this link for more information. Your midwife or doctor can let you know if this is safe for you to do and provide the collection kit and education.

 

More information about GDM can be found on the NDSS site here

On-line diabetes support (every 2nd Monday) from a midwife

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A midwife from Wollongong Hospital provides information about GDM and expressing milk for your baby every second Monday 1-2pm.

Call the antenatal clinic at Wollongong Hospital to book in: Ph. 4253 4256 or 4253 4284 or talk to staff when you are next at the clinic.

The best time to do this class is 35-36 weeks pregnant.

After you have booked in, a text message will be sent to you before the session with details of how to log in.

The classes will talk about what to expect when you are admitted to hospital when you have GDM and information about hand expressing for you to collect colostrum and bring into hospital for baby (in case of hypos).

More information is in the link below (Antenatal hand expressing of breastmilk (colostrum) from 36 weeks of pregnancy) 

 

Antenatal HAND EXPRESSING of breastmilk (colostrum) from 36 weeks of pregnancy

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You may be encouraged to express your milk from 36 weeks of pregnancy to have a small store of milk available for your baby when he/she is born.

Please remember, it is very normal for you to only get very small amounts of colostrum (sometimes only a drop), but every drop helps! The amount of milk you make while you are pregnant does not predict the amount you will make for your baby after it is born.

Midwives at the hospital can give you all of the equipment you need and instruction.

We have an on-line education class every Monday 1-2pm.  Call the antenatal clinic at Wollongong Hospital to book in: Ph. 4253 4256 or 4253 4284.

We have midwives and a lactation consultant available to help you if you would like to talk to someone.

Information about hand expressing your milk is available here

  • Most women who have diabetes can begin expressing colostrum
  • As long as there are no risk factors, such as a history of pre-term labour or birth, this can start at 36 weeks gestation
  • Very small amounts of the colostrum will be stored in syringes and frozen, then brought into the hospital on the day baby will be born
  • Some women will get up to 1ml, some women get just a few drops, others none at all – this is more to do with the pregnancy hormones that the ability to be able to breastfeed the baby
  • each syringe should have you name and the date and time the colostrum was expressed - your hospital patient labels are good to use for this
  • Antenatal expressing is always done using hand expressing (a breast pump will not work with the tiny amounts you get in pregnancy)
  • A video can be found at the bottom of this page with more information about expressing your milk. Your midwife can also show you or answer any questions you might have.
  • The hospital will provide a kit which contains an information sheet, syringes with caps, and some little cups to help catch the drops.
  • The kit will come in a plastic bag to store syringes in the freezer.
  • Try to aim for 0.5 to 1ml in each syringe – if much less than that is expressed, the same syringe can be used over the rest of the day, putting the cap on and storing in the fridge in between expressing (one syringe for every 24 hours, with the time recorded that of the first session of the day)
  • Don’t be disappointed if there is only a very small amount collected, still freeze and bring to the hospital, it can still be used
  • On the day baby is to be born or labour starts put the bag with any syringes into a lunch box with an ice brick to keep cold and frozen and bring to the hospital
  • Your midwife will place it in the freezer to keep if baby’s blood sugars are low or if baby needs a little extra
  • If your baby is going to arrive before, or around, 36 weeks your midwife can help you to collect some colostrum when you are admitted to hospital
  • remember to do lots of skin to skin and frequent breastfeeding once your baby has arrived to keep their BGL's stable 

Breastfeeding support before and after baby

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During your pregnancy -

  • A virtual breastfeeding education group runs every Friday from 1 - 2 pm
  • Discuss booking into this class with your midwife or Antenatal Clinic staff 
  • This is for all parents, whether you are a first timer or you need a refresher
  • Both parents are welcome to attend from the comfort of your own home using your phone, computer or tablet

After discharge with baby - 

  • Most women will have a midwife from the hospital follow you up at home after discharge to help with feeding and your after birth care
  • A Child and Family Health nurse will contact you after discharge to make an appointment with them - they are very skilled in infant and young child feeding 
  • After birth breastfeeding education groups - ask your Child and Family nurse for more information or go to their Facebook group  https://www.facebook.com/ChildandFamilyHealthISLHD
  • Your midwife or nurse may refer you to a Family Care Centre for extra breastfeeding support
  • The Australian Breastfeeding Association - Breastfeeding Helpline 24 hours a day, to speak to a counsellor and get some advice call 1800 686 268
  • You could also look for a private Lactation Consultant (IBCLC) through LCANZ - https://www.lcanz.org/find-a-lactation-consultant/

Calling a diabetes educator or dietician

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The Illawarra Shoalhaven Diabetes Service will talk to you about how best to manage your diabetes such as healthy eating, staying physically active and checking your blood glucose levels.

The diabetes team will regularly look at your BGL's throughout your pregnancy. Routine appointments (a combination of phone, email and face-to-face) will be made to review your GDM until your baby is born.

Target levels for your BGLs will be advised by your diabetes team.

If your levels are above the targets you have been given, 3 or more times in a week, please call the diabetes educator on 1300 308 969.

You may also be able to see them in the Antenatal Clinic (certain days). Please ask reception staff in the antenatal clinic when you book your next appointment.