Gestational and Maternal Diabetes

What is Gestational/Maternal Diabetes?
Gestational Diabetes is a type of diabetes that can affect some women during their pregnancy. Diabetes is a condition where there is too much glucose (sugar) in the blood. Normally the amount of sugar in the blood is controlled by a hormone called insulin. For some women during pregnancy their sugar levels become very high and their body cannot produce enough insulin which leads to the sugar levels increasing. In most cases this condition develops after 28 weeks and usually resolves after the baby is born.

Who is at risk of developing gestational/maternal diabetes?
Some women are at a higher risk of developing gestational diabetes during their pregnancy.

Some risk factors include:

• If your body max index is 30 or more
• If you have previously had a baby which weighs over 10llbs.
• You had gestational diabetes in a previous pregnancy
• There is a family history of diabetes
• Your family origins are from India, Pakistan, or Bangladesh, black Caribbean or Middle Eastern

How is Gestational Diabetes Diagnosed?
Every woman with one or more of the risk factors for gestational diabetes should be offered a screening test for gestational diabetes. A woman may be screened for gestational diabetes at first antenatal appointment which takes place around 6-8 weeks into the pregnancy.

During this appointment a woman will be asked questions to ascertain whether she is at increased risk of gestational diabetes. If one of the risk factors are identified then you will be offered a blood test, this may also include a glucose tolerance test.

A glucose tolerance test is normally performed at 24-28 weeks. This involves a blood test being performed in the morning before you have eaten your breakfast. You are then given a glucose drink and another blood test is performed about 2 hours later to see how the body is coping with the glucose.

If such tests are not performed then this can lead to a delay in the condition being diagnosed for some women and this can result in complications which could have been avoided.

How is Gestational Diabetes Treated?
If a woman is diagnosed with gestational/maternal diabetes then advice will be given in relation to monitoring and controlling the blood glucose (sugar levels).

For many women changes to their diet and exercise will enable them to control their gestational diabetes. However, for some women it will be necessary to take medication to control their sugar levels. Further, it will be essential for the mother to learn how to monitor her blood glucose levels.

Once gestational diabetes is diagnosed your pregnancy will be monitored more closely as the unborn baby may be at risk of complications, such as the baby becoming very large. Some forms of monitoring which may be done include:

• An ultrasound scan at 18-20 weeks to check the unborn baby’s heart
• An ultrasound scan at weeks 28, 32, 36 and regular checks from week 38 of the pregnancy to monitor your baby’s growth and the amount of amniotic fluid (which surrounds them in the womb).

If the appropriate treatment is not provided or the mother and baby is not monitored appropriately during the pregnancy then this can lead to complications.

What happens when I give birth and I have gestational diabetes?
During the pregnancy the mother’s blood sugar levels will have been monitored closely. If the blood sugar levels are within the normal levels and there have been no issues detected with the baby then the labour can proceed naturally. However, some women are offered the opportunity to have their labour induced (started) after week 38.

If the baby is noted to be particularly large for its gestational age the medical professionals will discuss the possibility of performing a cesarean section.

When a women has gestational diabetes they should give birth in a hospital setting to ensure there is sufficient monitoring.

During the labour mother’s blood sugar levels will be measured every hour to ensure they are kept at a certain level. If the mother has been taking insulin then it may be necessary to continue to receive this medication on a drip during the labour.

When the baby is born, their blood glucose levels will be measured. If their sugar levels are noted to be low then they may be fed via a drip. Some babies have to be monitored closely in the neonatal unit.

After giving birth if any medication had been prescribed to control the sugar levels this will normally be stopped straight away. The mother’s blood glucose levels will normally be tested about 6-12 weeks after giving birth to ensure the sugar levels have returned to normal. Further, the mother’s weight and waist measurement will be monitored and advice will be given in relation to diet and exercise. The mother should be given information on the symptoms to be aware of which could be an indicator the diabetes has returned.

Symptoms of high blood sugar levels are:
• Increased thirst
• The need to urinate frequently
• Tiredness

Symptoms of low sugar levels are:
• Feeling hungry
• Trembling or shakiness
• Sweating
• Anxiety or irritability
• Turning pale

The mother will still require a blood test once a year to see whether they have developed type 2 diabetes.

What happens if gestational diabetes is not treated properly?
For most women with this condition they proceed to have a normal pregnancy. However, if this condition is not diagnosed and managed properly during the pregnancy then complications can arise. It is essential that the levels of glucose/sugar in the blood is monitored and controlled during the pregnancy.

If gestational diabetes is not diagnosed or managed properly some of the complications which can occur include:
• Large baby (i.e. weighs more than 8.8lbs)- if you have a large baby it may make it necessary to undergo a caesarean section, induced labour and birth complications such as shoulder dystocia. If a caesarean section is not offered in a timely manner then this can lead to complications and the baby may be starved of oxygen. If the starvation of oxygen is severe then the baby can develop Cerebral Palsy
• Premature birth this can cause problems for the baby as they will not have developed fully
• The baby may develop some complications such as low sugar levels
• Miscarriage
• Stillbirth

A women who has suffered from gestational diabetes is at an increased risk of developing type 2 diabetes after the pregnancy. Therefore, it is essential that the mother’s blood sugar levels are monitored after giving birth to ensure it returns to the normal levels.

Has my treatment for gestational diabetes been negligent?
If there is failure to diagnose or manage gestational diabetes it can have serious consequences for mother and baby.

Negligence can occur when:
• There is a failure to screen the mother and identify her as being at risk of gestational diabetes;
• There is a failure further on in the pregnancy to recognise the mother has developed symptoms of gestational diabetes;
• There is a failure to perform the tests at the appropriate stages in pregnancy to diagnose this condition;
• The condition has been diagnosed but the treatment plan is not appropriate;
• The condition is diagnosed but there is a failure to recognise complications are occurring;
• The birth is not managed appropriately;
• There is a failure to monitor the mother or baby after birth which results in complications.

When there is a failure to diagnose, treat or manage this condition then complications which can occur include miscarriage, stillbirth, premature birth, and the baby being large which can result in complications during labour.

If you believe that the treatment you have received for your gestational diabetes was not appropriate and negligence has occurred, please contact us today for a free, no obligation chat.