Gestational diabetes

Diabetes appearing in pregnancy. Usually resolves after birth, and it is a warning about the next twenty years.

What it is

Gestational diabetes affects a substantial proportion of pregnancies in the UK, and rates are rising.

Pregnancy hormones increase insulin resistance. In most people the pancreas keeps up; in some it does not, and blood glucose rises.

It usually resolves after delivery. What does not resolve is the risk it reveals: around half of people who have gestational diabetes develop type 2 diabetes within ten years.

That is the piece most often lost. The postnatal follow-up test is frequently not done, the annual check afterwards is rarely arranged, and a decade later somebody is diagnosed with type 2 that could have been delayed or prevented.

Signs you might notice

Usually none, which is why screening exists.

Screening with an oral glucose tolerance test is offered around 24 to 28 weeks to those with risk factors: raised BMI, a previous large baby, a previous gestational diabetes, a family history, or certain ethnic backgrounds including South Asian, Black African-Caribbean and Middle Eastern.

Occasionally: thirst, passing urine more, tiredness, or a large baby detected on scan.

How it can affect day-to-day life

The monitoring burden is real: finger-prick testing four or more times a day, alongside everything else pregnancy involves.

Guilt is very common and misplaced. Gestational diabetes is largely determined by genetics and physiology, not by what somebody ate.

Well controlled, outcomes are good. Poorly controlled, risks include a large baby, birth complications, and neonatal hypoglycaemia.

The postnatal glucose test at six to thirteen weeks, and an annual HbA1c thereafter, are the two things to insist on.

Supporting someone well

Test as advised and record it. Patterns matter more than single readings.

Eat regularly with slower-release carbohydrate, and walk after meals; a short walk after eating lowers glucose measurably.

Accept insulin or metformin without treating it as failure. Many people need it whatever they eat.

Book the postnatal glucose test and go to it. This is the step most often skipped.

Ask for an annual HbA1c afterwards, for life, and mention gestational diabetes at any future GP registration.

Breastfeeding, where possible, reduces future type 2 risk for both parent and child.

Where to get help

A midwife and the joint diabetes and antenatal clinic manage this.

Diabetes UK have a gestational diabetes section and a helpline on 0345 123 2399.

Reduced fetal movements at any point need immediate contact with maternity triage, regardless of glucose.