Gestational Diabetes

Dr Paul Grant MRCP is Consultant Physician in Diabetes and Endocrinology at the Oxford Centre for Diabetes, Endocrinology and Metabolism, and Editor-in-Chief of The British Journal of Diabetes.

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Depression and Anxiety the Drug-Free WayMark Greener

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Dr Dawn’s Guide to Digestive HealthDr Dawn Harper

Dr Dawn’s Guide to Healthy Eating for DiabetesDr Dawn Harper

Dr Dawn’s Guide to Healthy Eating for IBSDr Dawn Harper

Dr Dawn’s Guide to Heart HealthDr Dawn Harper

Dr Dawn’s Guide to Sexual HealthDr Dawn Harper

Dr Dawn’s Guide to Toddler HealthDr Dawn Harper

Dr Dawn’s Guide to Weight and DiabetesDr Dawn Harper

Dr Dawn’s Guide to Women’s HealthDr Dawn Harper

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Overcoming Common Problems

Gestational DiabetesYour survival guide to diabetes in

pregnancy

DR PAUL GRANT

First published in Great Britain in 2016

Sheldon Press36 Causton StreetLondon SW1P 4ST

www.sheldonpress.co.uk

Copyright © Paul Grant 2016

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical,

including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.

The author and publisher have made every effort to ensure that the external website and email addresses included in this book are correct and up to date at the time of going to press. The author and publisher are not responsible for the content, quality or continuing accessibility of the sites.

British Library Cataloguing-in-Publication DataA catalogue record for this book is available from the British Library

ISBN 978–1–84709–441–4eBook ISBN 978–1–84709–442–1

Typeset by Fakenham Prepress Solutions, Fakenham, Norfolk NR21 8NNFirst printed in Great Britain by Ashford Colour Press

Subsequently digitally reprinted in Great Britain

eBook by Fakenham Prepress Solutions, Fakenham, Norfolk NR21 8NN

Produced on paper from sustainable forests

To Clare, Henry and Molly with love

ix

Contents

Glossary xi

Note to the reader xiv

Introduction xv

1 Understanding gestational diabetes – what is it and why me? 1

2 What next? Coming to terms with the diagnosis 14

3 Antenatal care – being supported during pregnancy 20

4 Diet and lifestyle – the cornerstones of gestational diabetes management 34

5 Now you’re telling me that I have to exercise?! 55

6 Medication to help protect you and your baby 61

7 Progressing in later pregnancy 84

8 Getting ready to deliver 94

9 After the birth 102

Useful addresses 106

Notes 107

Index 109

xi

Glossary

It’s easy to forget that a lot of the time we use medical and tech-nical language that is not familiar or easily understandable. During a degree in medicine it is not uncommon to learn between 20,000 and 30,000 completely new words – this is roughly the equiva-lent of two new languages. It is unsurprising therefore that when doctors, nurses and midwives communicate with patients there can be confusion and misunderstanding. This is a guide to commonly used medical terms that you may come across in the antenatal diabetes world.

4D scan a new type of ultrasound technology which provides more detail and show’s baby’s movements

antenatal anything related to the time before birth or during preg-nancy or relating to pregnancy

BM the shortcut name given to blood glucose levels (named after the company Boehringer Manheim who used to make the test glucose strips), sometimes also called CBG (see CBG)

caesarean section a way of delivering baby – a surgical procedure which involves making a small cut in the lower abdomen in order to get baby out

carbohydrate the name given to sugars and starch within foods which are broken down into glucose in the body and used for fuel, growth and repair

CBG (capillary blood glucose monitoring) the term describing finger prick blood glucose testing from the small blood vessels (cap-illaries) in the fingertips

CTG (cardio-tocograph) a sensor device usually strapped to your tummy with an elastic belt which allows the midwife to monitor baby’s heartbeat during labour and delivery

diabetes mellitus a term generally describing too much sugar (or glucose) in the blood; it does not mean that you are eating too

xii Glossary

much sugar in your diet, it means that your body is having dif-ficulty controlling the levels of sugar either because there is not enough insulin (see insulin) being produced or there is resistance to the action of insulin working effectively

diabetologist a doctor with special training and experience in looking after people with diabetes

fasting a period of time without eating or drinking or relating to the stage just before a meal is taken, e.g. ‘the fasting blood glucose level was normal before lunch’

G6PD deficiency glucose-6-phosphate deficiency, a disorder of red blood cells

gestation the period of developing inside the womb between con-ception and birth

GI (glycaemic index) a ranking of carbohydrate-containing foods, based on their effect on blood glucose levels, from 0 to 100. Pure sugar has a GI rating of 100

glucometer the glucose checking machine, normally a small hand-held device which consists of a digital meter into which test strips are inserted. A droplet of blood is placed on the test strip and the meter then generates a blood glucose measurement value

haemoglobin A1c ‘glycosylated haemoglobin’ – a measure of long-term glucose exposure

hyperglycaemia a high blood glucose reading. This can affect the unborn baby and can be associated with feeling unwell or irritable, feeling thirsty, increased frequency of urination and blurring of your eyesight

hypoglycaemia a low blood glucose value. This can be associated with feeling unwell, hungry, drowsy and dizzy

induction of labour the action of bringing about labour

insulin an important hormone (chemical messenger) which nor-mally causes glucose from the bloodstream to be taken up into the tissues, such as the muscles or the brain where it can get to work.

Glossary xiii

Synthetic forms can be used as a medication when an individual is not producing enough of his or her own insulin

insulin resistance is when the body cannot adequately handle high glucose levels due to ineffective action of insulin

macrosomia literally means ‘big body’ and means a large baby

obstetric relating to pregnancy, childbirth and the processes associ-ated with it

obstetric cholestasis a blockage to the flow of bile from the gall bladder into the gut. There is an increased likelihood of this hap-pening in pregnancy

obstetrician a doctor with special training in how to care for preg-nant women and delivering babies

OGTT (oral glucose tolerance test) a special investigation used to see how well your body can handle a set amount of sugar as part of a ‘challenge’ test

polyhydramnios an excess of the fluid around baby within the uterus which can have multiple causes – gestational diabetes being a common one. The diagnosis is made by ultrasound; the signifi-cance can depend on how big the pool of fluid is

post-prandial the time following consumption of a meal. Usually in the context of gestational diabetes, this relates to 1 hour after eating, e.g. ‘the post-prandial blood sugars were all high’

pre-eclampsia high blood pressure in pregnancy

premature birth a baby being born more than 3 weeks before it is due; generally this is taken as 37 weeks or less (full term being 40 weeks or 9 months)

xiv

Note to the reader

This is not a medical book and is not intended to replace advice from your doctor. Consult your pharmacist or doctor if you believe you have any of the symptoms described, and if you think you might need medical help.

xv

Introduction

Having a baby is one of the most amazing, special and stressful experiences that someone can go through. It can be exhausting, scary and strange, the expectant mother sometimes finding herself veering from glowing with happiness to unexpectedly welling up with tears.

In the midst of this cocktail of physical and emotional stress, a diagnosis of diabetes can come as a bewildering shock and sur-prise. Gestational diabetes, or GDM, has been around for as long as women have been having babies; however, until recent years, its effects have often been unrecognized and poorly understood and there was no way of testing for it or treating it satisfactorily. It is now thought that GDM affects 15 per cent of all pregnancies world-wide (in India alone there are an estimated 4 million women who have GDM) and there are plenty of famous women out there who have also experienced this including Salma Hayek, Mariah Carey and Angelina Jolie.

Fortunately, we now live in an era where the medical profes-sion and the general public know a lot more about diabetes in pregnancy, midwives are able to screen for it with ease and special antenatal clinics have been set up to allow careful and considerate management of the condition.

If you have recently been diagnosed with gestational diabetes, or are the partner or relative of someone with this condition, the goal of this book is show you that you are not alone. With the right understanding, lifestyle changes and self-management, ges-tational diabetes can be demystified. The text is framed as a series of (hopefully) straightforward and comprehensive questions and answers relating to many aspects of the condition that come up time and time again. Remember, being diagnosed is a good thing. Even though it will take some extra time and effort to get your sugar levels under control it will be worth it for you and your baby’s health.

This book is based on a combination of many years’ experience in the diabetes antenatal clinic and the successful multi-disciplinary

xvi Introduction

approach of obstetricians, midwives, diabetes specialist nurses, diabetologists and dieticians working together and sharing the care of women with diabetes. It is with great thanks and respect to the teams in Brighton, Oxford, Tunbridge Wells, and Guy’s and St Thomas’ Hospitals that this book is jointly dedicated.

There is a glossary at the beginning of the book with explan-ations for all the words written in bold type.

1

1Understanding gestational

diabetes – what is it and why me?

Elizabeth and her partner, Jon, were very happy to discover that she had become pregnant after months of trying. After the early morning (and afternoon) sickness had settled and the 12-week scan went okay they started telling all their family and friends their good news. They were making plans, cautiously buying equipment for the nursery and debating which pram and pushchair combination to buy. Claire, the community midwife, was very helpful and explained about all the routine tests and checks that were needed during preg-nancy. Elizabeth had initially been rather anxious about labour and delivery as she had some friends who’d had bad experiences, but Claire was able to allay her fears. Elizabeth was fit and healthy and had never been into hospital in her life. Claire talked to her about her personal risks of developing problems during the pregnancy and arranged various blood tests and the like. Elizabeth was sure that there were no major medical problems that ran in her family – but her mum, who had come with her to see the midwife, said that there were a couple of close rela-tives out there with a history of diabetes and a few big babies had been born recently, including to Elizabeth’s half-sister Kate. Because of this background, Claire said that it would be a good idea to screen her for gestational diabetes and arranged to get her tested.

What is gestational diabetes?

During pregnancy (or gestation) the human body undergoes many changes and there is a huge amount of metabolic stress due to the significant demands of growing another human being inside you. The normal fuel supply to provide energy and growth is glucose (a type of sugar that comes from carbohydrates within our diet), and this is well regulated within a tightly controlled range. The hormone which normally helps to control blood glucose levels is called insulin and this is a type of chemical messenger which