The position statement has been developed to inform women who may be at risk of, or who develop, gestational diabetes mellitus (GDM) and also to inform the community, policy makers and health care providers. It is not intended as a clinical guidance document for health professionals. The position statement addresses the diagnosis, management and post-pregnancy care of women who develop GDM. It provides an overview of key issues relating to GDM and its impact and makes recommendations about the care and support women should receive.
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During pregnancy a women’s body undergoes many changes to provide the best possible environment for the developing baby. Most of these happen naturally and without problems. Sometimes, however, the body is unable to make all of the necessary changes and therefore requires a little help. One of the problems that can develop during pregnancy is a condition known as Gestational Diabetes. Gestational Diabetes means the body is unable to adapt to the changing amounts of pregnancy hormones as your baby and placenta grow. When baby is born, in most women Gestational Diabetes disappears. In Gestational Diabetes the blood glucose level of the woman is raised above normal ranges for pregnancy.
This extra glucose in your (mum’s) blood has been shown to increase the risk of some health problems during pregnancy and following birth of your baby. The Australasian Diabetes in Pregnancy Society, as well as other world authorities on diabetes, recommend that each woman be tested during their pregnancy, for diabetes.
No. There is no risk of your baby being born with diabetes as a result of having Gestational Diabetes.
It is very likely that the diabetes is only associated with pregnancy, and in almost every case, will go away as soon as the baby (and placenta) are born. As you have been identified with the gene for diabetes you are at risk of developing diabetes some time in the future. ADIPS recommend that you be tested 6 - 12 weeks following birth of your baby, and again each 2-3 years.
The immediate risk for baby if blood glucose remain uncontrolled is becoming overweight which makes birth difficult. Large infants can mean an episiotomy (cut in the perineum to allow baby to be born), a forceps delivery or caesarean section. Learning to control blood glucose levels within normal range can reduce these risks significantly. Babies born to mothers with undiagnosed Diabetes or who have been unsuccessful in controlling blood glucose levels are more likely to be overweight as children. This may increase the child’s risk of health problems (eg high blood pressure, heart disease and diabetes) in the future.
In Australia, about 5%, or one woman in every 20, are effected. Statistics are generous as not all women are screened for diabetes in pregnancy. The number of women developing GDM is increasing, and is more common in women of certain ethnic groups (Asian, Indian, Mediterranean, Indigenous) and older than 30.
This is true for women who have diabetes before they get pregnant (usually Type 1 Diabetes). It is not generally a problem associated with Gestational Diabetes.
One of the aims of management during pregnancy is to reduce the risk of separating mother and baby when born, ie taking baby to special care nursery. Discuss the care and policy with your obstetrician or staff at your place of birth. Better understanding and knowledge of gestational diabetes has reduced the risk of baby needing to go to special care nursery for observation.
Yes. You have the right to choose how you feed your baby. The baby will not develop diabetes or gestational diabetes from breast milk.Your baby will be tested for low blood glucose levels (blood test from heel prick) on the first day and early breastfeeding (within half an hour of birth) will assist baby to maintain normal levels of blood glucose. Talk to your midwife about strategies to reduce separation time of you and your baby and steps to take for successful breastfeeding.
It is possible in some women that gestational diabetes may be present and could have been diagnosed at an earlier stage of pregnancy. However, few women develop gestational diabetes earlier. Gestational diabetes is most commonly found during the last 12 weeks of pregnancy as the pregnancy hormone levels rise further. At 28 weeks, control of blood glucose levels can be effective in controlling the growth of the baby.
There was no problem in my last pregnancy / no one in my family has diabetes / my diet is healthy / I do lots of physical activity. There are certain risk factors associated with the development of gestational diabetes. Age, weight, family history of diabetes or previous complicated pregnancy are the main risk factors. Gestational diabetes may occur in women with no identifiable risk factors. This is why ADIPS recommend that every woman be screened at 24-28 weeks.
The level of blood glucose is only a predictor of potential problems. Generally, the higher the level the higher the risk. Blood glucose levels rise as the pregnancy progress, you and your baby are still at risk if no education and management of blood glucose occurs.
Between 10% - 25% of all women with gestational diabetes need to use insulin injections as part of their treatment. The best method of determining this need is by checking your blood glucose levels daily as recommended by your Doctor or Diabetes Educator. No proof yet exists that tablets are a safe way of controlling blood glucose levels during pregnancy. Trials are in process and some women may continue to use their diabetes tablets under supervision during pregnancy.
No one can give you a full guarantee that problems will not occur during your pregnancy. Being aware of gestational diabetes is your chance to lower the chances of a problem occuring. In many cases of Gestational diabetes, the health of mother and baby is better than in other pregnancies because of the extra information and care you take in maintaining a healthy lifestyle. The close supervision by your obstetrician/ doctor and other specialists work with you towards a healthy pregnancy, baby and child.
These patient education resources have been developed by the GDM Project Team for the Statewide Diabetes Clinical Network (QLD Health). They have been translated into the following languages and are intended for assisting when clinicians are educating a woman on self administration of insulin or commencing Metformin. It is preferable to have an appropriate interpreter present or linked by phone but this is not always possible. They are available for downloading and using in your practice.
GDM Insulin Therapy Booklet
GDM Metformin Brochure
For Australian Aboriginals there is lack of culturally secure educational resources available for health professionals working in the field of diabetes in pregnancy. The ADIPS Educational Research prize (Novo Nordisk) resulted in the development of some of the new ADIPS resources.
Over a five-year period, Aboriginal women with diabetes attending antenatal clinics were recruited for focus groups or for individual participation. These resources were developed in the areas of maternal and infant health with the focus on nutrition for pregnancy, diabetes in pregnancy for self-management, PCOS, conception and contraception. A cyclical and iterative approach was used to develop, evaluate and correct educational resources with further testing of the resources with various Aboriginal language groups for transferability. Special thanks goes to members of ADIPS, Dr Shelly Wilkinson and Dr Susie De Jersey who peer reviewed the resources, all are considered experts in the field of Diabetes in Pregnancy and approved the technical content.
As a result ADIPS now has a comprehensive series of educational resources suitable for health professionals or members of the public. The resources are easily downloaded and reproducible, in a variety of formats ranging from simple brochures, diary formats, in a Power Point (Microsoft) format or printed as flip charts to be suitable for yarning groups.
The ADIPS Educational Research prize has resulted in an extensive, comprehensive and culturally secure collection of educational resources suitable for Australian Aboriginal women. These resources have approval by the ADIPS council to be hosted on the ADIPS Website as a resource for health professionals working in the field of diabetes in pregnancy or for pre-conception use in general diabetes clinics.
Contact: Dr Cynthia Porter PhD (UWA), Advanced Accredited Practising Dietitian (AdvAPD, AdvAN), Credentialled Diabetes Educator (CDE), Certified Insulin Pump Trainer (CPT); Email Dr Cynthia Porter at: firstname.lastname@example.org
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