Pregnancy-related diabetes occurs in fewer than 5 out of 100 pregnancies. However, it is important to diagnose as can have implications not only for you but also your baby. Issues for you range from symptoms like increased thirst, needing to pass urine more often and fatigue to pre-eclampsia and type 2 diabetes developing later in life. Problems that can occur for your baby including large birth weight, a complicated birth and needing more support once they are born sometimes in a neonatal unit.
Therefore, it is important not to miss. There are certain women who are at higher risk of developing it, these are women:
- Who smoke
- Have higher body mass index (overweight and obese)
- Who are older
- Who are of certain ethnic groups (Asian, African Americans, Hispanic/Latino Americans and Pima Indians)
- Who have had a short interval between pregnancies or gained weight between pregnancies
- Who have had a previous unexplained stillbirth or previous baby born who is significantly larger than average (macrosomia)
- Who have a family history of type 2 diabetes/gestational diabetes (this is most relevant for women who have not been pregnant before)
As you can see, some of these factors are modifiable. For example, if you are overweight or obese, it is worth losing weight prior to conceiving and, if you are obese, seeing your doctor for support this with. There are options from medication to help you lose weight, exercise programmes as well as weight loss surgical options (bariatric surgery). If you have a risk factor that you cannot change like your family history or your age, you can do regular exercise prior to and during your pregnancy – there is some evidence this decreases the risk of developing pregnancy-related diabetes.
You may be wondering, how would I know if I had it? As I mentioned before, some women develop symptoms or their midwife may detect sugar in their urine on routine testing and they will then be tested for it using the two-hour 75g oral glucose tolerance test (OGTT).
Furthermore, the National Institute for Clinical Excellence (NICE) recommends that if a woman has had pregnancy-related diabetes in a previous pregnancy they should be offered either early self-monitoring of blood glucose or the OGTT as soon as possible after booking.
NICE also recommends screening (using the OGTT) for certain higher risk women between 24 and 28 weeks of pregnancy:
- Those with BMI >30kg/m2
- Previous baby born at or over 4.5kg
- Previous pregnancy-related diabetes
- First-degree relative with diabetes
- Family origin with higher prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)
What happens at the OGTT?
Women are asked to fast from midnight – they are able to have sips of water only. They then have a blood test first thing in the morning. After this, the woman is given 75mg glucose (sugar) dissolved in water to drink within a 10-minute time period. 2 hours later a further blood sample is taken from the woman.
The results will then come back showing what the glucose level is first thing in the morning and what it is 2-hrs after the glucose drink. This enables midwives and doctors to tell if the woman is not-diabetic, whether she has impaired glucose tolerance or whether she has diabetes.
What happens if the OGTT is abnormal?
If the result shows impaired glucose tolerance or pregnancy-related diabetes you will be followed-up closely by a doctor specialising in this in order to reduce the risks of complications for you and your baby. If you have concerns at any time, talk to your midwife.
What happens if I am not offered the OGTT at the right time?
NHS options: It has come to my attention that certain high-risk women are being offered the OGTT late due to constraints on the NHS. It is worth asking your midwife whether you could get it done earlier at another location or whether there is a process for being put on a waiting list for cancellations. Help your midwife by having the number of weeks you currently are and the reason you need the OGTT with you when you contact them as well as your name, DOB and hospital number. If you have the test done in another hospital, do ensure that the results are sent to your midwife (sometimes hospital trusts and community services are not well linked and you cannot assume your midwife will receive them at all or if they do whether it will be in a timely fashion).
Private options: If you cannot get this done on the NHS at the right time and you are able to afford it, your other option is having it done privately. If you decide to do this, do check what exactly you are offered as part of the service:
- Where will the test be done?
- Will you get clear instructions about what you need to do to prepare for it?
- Who will do the test?
- What laboratory will be used to analyse your results?
- When will you get your results?
- How will you get your results e.g. on phone, in person, in written format, by electronic means?
- Will somebody be available to help you understand the results?
- What will they do if your results are abnormal, e.g. will they contact your midwife or booking hospital for you?
- Is the private clinic you have chosen used to doing the test for pregnant women (as it is also sometimes used for other people who are not pregnant for other indications)?
If you decide to have the test done privately, let your midwife know and ensure they have got your results. Unfortunately, the private sector and NHS are not well linked communication wise so you may have to ensure the transfer of information yourself. When PregnaPouch is live you will be able to use this for that purpose.
If you have further queries or comments do post them in the comments below or get in touch @PregnaPouch or PregnaPouch@gmail.com.
The PregnaPouch team
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