Gestational Diabetes

Gestational Diabetes


Hello. My name is Dr. John Regan,
and I’m the lead obstetrician in charge of the Opal Team at
Monash Medical Centre Clayton. The Opal Team
specialise in looking after women whose pregnancies
are complicated with diabetes. You’re most likely watching
this presentation either because you’ve been diagnosed
with gestational diabetes or because you may have
an interest in this area. Gestational diabetes,
which we also call GDM, is defined as diabetes,
which occurs in pregnancy and which is not present when
the pregnancy is finished. It occurs because
the hormones, which are helping to grow your baby,
oppose the action of insulin, which is the hormone responsible
for lowering blood sugar levels. Because of this,
pregnant women need to produce more insulin to
overcome this resistance. While most women can
do this, some cannot. And it is this group who may
develop gestational diabetes. Gestational diabetes is a
completely different condition to preexisting diabetes,
and the two conditions should not be confused. Very few women, diagnosed
with gestational diabetes, will experience any symptoms
or signs of the condition. Increased thirst and
urinary frequency are very common
conditions of pregnancy and not a sign you may
have gestational diabetes. We recommend that all pregnant
women have a test for GDM. This test consists of a
fasting two-hour test, where you’re given
a glucose drink and then have a blood test
performed, initially at one hour and at two hours
after the drink. Gestational diabetes
is diagnosed if these results are abnormal. We generally recommend
this test is performed around 26 to 28 weeks’
gestation in most women. Your doctor or
midwife may suggest the test is done earlier, if
you’ve had gestational diabetes in the past or any other history
or factor, which may increase your likelihood
of being diagnosed with gestational diabetes. If the test is
abnormal and you’re diagnosed with
gestational diabetes, we will refer you to a diabetes
educator, who will teach you how to monitor
your blood sugars, which we also call BSLs. This is done by pricking
the end of your finger to get a small sample of
blood onto a test strip. We then put the test
strip into a machine, called a glucometer, which tells
us your blood sugar levels. We will want you to do
this four times a day, first thing in the morning prior
to eating, and then an hour and a half after each meal. We will ask you to
record these readings in a book, which
will be given to you. Your blood sugar levels
will vary, depending on your diet and
level of activity. We may need to review
your diet and encourage you to do more exercise,
so that your blood sugar levels can be kept
in the normal range. For most women, this is
all that will be needed. Some women will continue to have
high blood sugar levels, even if they’ve changed their diet
and their level of activity. These women may need
to be given insulin to bring their blood sugar
levels back to a normal range. This is important,
as high blood sugar levels can have an impact upon
your body and upon your baby, so it is really important
to monitor and try and keep your blood sugar levels
in the normal range. Provided the BSL
levels are normal, most women diagnosed with
gestational diabetes will not need any change to the type of
care they’re receiving and will not need antenatal CDG
monitoring or induction of labour, unless there are
other indications for this. After the birth of
your baby, we will want to monitor your
baby’s blood sugar levels in the first 24
hours of their life. If these are normal, we do not
need to do anything further. If they are low, we may need
to give your baby a little bit of extra milk, such as some
of your expressed breast milk or occasionally some formula. After giving birth,
your hormones that have caused you to have
gestational diabetes will go, and your blood sugar
levels will rapidly return to a normal range. We may still ask you to do some
blood sugar levels while you’re in hospital, to
check that they have returned to a normal level. The early diagnosis and
treatment of diabetes is very important,
and some women diagnosed with
gestational diabetes, will develop diabetes
later in life, and so we’d recommend follow-up
with your GP following the birth of your baby and then
subsequently every two years to ensure you do not become
diabetic later in life.

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