How do you treat diabetes during pregnancy?

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Why is it important to treat gestational diabetes?

Globally about 18% of pregnant women develop gestational diabetes as a result of not being able to produce enough insulin needed in pregnancy, the risk accumulating as the pregnancy develops and baby gets larger. In some countries and among certain ethnic groups the risk of gestational diabetes is greater along with factors such as your mother having diabetes; being overweight or previous gestational diabetes in pregnancy.

Controlling blood sugars minimizes risk of baby being large for gestational age at birth and as a consequence reducing the likelihood of developing pre-eclampsia; needing induction or requiring a caesarean-section. It also decreases the chances of baby not experiencing complications related to sudden changes in blood glucose levels once the umbilical cord is cut and it no longer has the blood supply of its mother (known as hypoglycaemia). These are all really important reasons to get it right in pregnancy and many doctors are now prescribing metformin with very positive outcomes at birth.

For can find more information about the complications of untreated diabetes in pregnancy, in our article gestational diabetes complications.

How do I treat gestational diabetes?

If you have gestational diabetes, it is important to regularly monitor and control your blood glucose levels to keep you and your baby healthy. This is important, as it can help you to avoid any complications for you and your baby during pregnancy and delivery, as well as later in life.

The treatment of gestational diabetes is similar to the treatment of type 1 and type 2 diabetes. However, in gestational diabetes, treatment options need to also account for the growing baby.

The preferred method of managing gestational diabetes is through lifestyle management, such as diet and exercise. For some women, they may be required to take medications in pregnancy, for example metformin. Metformin is a common drug recommended for gestational diabetes, which has been shown to be safe for use in pregnancy.

Healthy diet

Any recommended changes to the diet are based around optimal nutrition for the mother and infant, and controlled weight gain. Like with a type 2 diabetes diet, eating the right types of food during pregnancy can help to control your blood glucose levels and avoid excess weight gain.

Women with gestational diabetes need to eat a balanced diet that contains nutrients from all food groups. It is best to completely avoid a keto diet as this may be seriously harmful for the baby. The best diet involves eating a little of everything but not too much. Diabetes and diet in pregnancy is a helpful article outlining what to eat.

Exercise

Regular physical activity plays a key role in before, during, and after pregnancy. Exercise is very beneficial in aiding with controlled weight loss. Exercise is able to lower blood glucose levels by increasing your cells’ sensitivity to insulin. This means your body needs to produce less insulin to transport glucose from the blood stream and into your cells.

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Blood glucose monitoring

Your doctor or endocrinologist may ask you to check your blood glucose levels regularly throughout the day, including when you first wake up in the morning, and after you eat your meals. This is to make sure that your blood glucose levels are staying in a safe range.

You can test your blood glucose levels with a blood glucose meter by placing a drop of blood on a test strip. You can use a lancet (a small needle) to produce a drop of blood. Once the blood is applied to the test strip, it is then inserted into the blood glucose meter, which will display your blood glucose reading.

Metformin in pregnancy

Metformin can be used alone or with the addition of insulin if sugar levels are still too high. Not having to inject, less risk of low blood sugars and few side effects, the benefits of use are easy to see. Side effects if experienced are most commonly nausea and diarrhoea which should settle soon after commencing.

There is always about 3-5% risk of a baby being born with a birth defect and the US Food and Drug Administration (FDA) has now stated that as studies in animals have not demonstrated any risks that it is considered ‘safe’ for use but also state that there are no ‘adequate and well- controlled studies in pregnant women’. The Therapeutic Good Association (TGA) currently list metformin as a category C which means that its use is off label until there is more evidence of its safety.

Follow up studies such as with the MiG trial now have data up to about 7 years of age of babies exposed to the drug but not beyond and as metformin does cross the placenta it is really important to continue to monitor their growth patterns into adulthood.

Commonly metformin is prescribed during the second and third trimester of pregnancy when dietary changes are not enough. It is also now used prior to pregnancy in those with polycystic ovarian syndrome (PCOS) in providing real help to those finding it hard to become pregnant in the first place. This is because it helps regulate blood sugars and aids weight loss in provision of the right environment for pregnancy to occur.

Studies are ongoing but it seems in addition, if started before pregnancy or in the first trimester, metformin may help those in other high-risk groups such as those with previous history of gestational diabetes; pre-diabetes or being overweight.

If you want to learn more about metformin use during pregnancy, you can read our article Metformin in Pregnancy: Is it safe? for more information.

Plan ahead

Planning for a pregnancy is the best way to ensure you’re in the best health prior to conception. Regular GP appointments are a helpful first step in planning for a future pregnancy. Your GP will be able to suggest appropriate pre pregnancy blood tests and check-ups. A catch up with your dietitian and an exercise physiologist may also be useful when planning ahead.

Just remember, there is a chance, despite doing all the right things that gestational diabetes can still occur. But remember, following a healthy diet and being active may reduce the severity of gestational diabetes, reduce the need for insulin and the risk of further complications.

What should I do next?

If you experience any symptoms of gestational diabetes or you have risk factors for developing gestational diabetes, it is important to be tested at 24-28 weeks gestation. Some people are at higher risk than others. If you are 25 years or older or have other risk factors for diabetes, you may require testing earlier in pregnancy. By diagnosing and treating gestational diabetes, it means you can decrease the risk of developing or delay any further health complications of gestational diabetes. These complications can affect both you and your child later in life, for example you are both at risk of developing type 2 diabetes. It is important to know that diagnosing diabetes should not rely solely on using a Hb A1c test.

Once you learn what your gestational diabetes status is, or if you already have gestational diabetes, the next most important step is to become educated. You can join the Gestational Diabetes Program to help you learn how to manage gestational diabetes and improve health outcomes for you and your child. The program is personalised and tailored, giving you more of the content that you want. The program also helps you to stay motivated and teaches you what changes you need to make.

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