Treatment

If you have gestational diabetes, the chances of having problems with the pregnancy can be reduced by controlling your blood sugar (glucose) levels.

You'll also need to be more closely monitored during pregnancy and labour to check if treatment is working and to check for any problems.

Checking your blood sugar level

You'll be given a testing kit that you can use to check your blood sugar level.

This involves using a finger-pricking device and putting a drop of blood on a testing strip.

You'll be advised:

• how to test your bloodsugar level correctly
• when and how often to test your blood sugar most women with gestational diabetesare advised to test before breakfastand one hour after each meal
• what level you should be aiming for this will be a measurement given in millimoles of glucose per litre of blood (mmol/l)

Diabetes UK has more information about monitoring your glucose levels .

Diet

Making changes to your dietcan help control your blood sugar level.

You should be offered a referral to a dietitian, who cangive you advice about your diet, and you may be given a leaflet to help you plan your meals.

You may be advised to:

• eat regularly usually three meals a dayandavoid skipping meals
• eatstarchyand low glycaemic index (GI) foods that release sugar slowlysuch as wholewheat pasta, brown rice, granary bread, all-bran cereals, pulses, beans, lentils, muesli and porridge
• eat plenty of fruit and vegetablesaimfor at least five portions a day
• avoid sugary foods you don't need a completely sugar-free diet, but try to swap snacks such as cakes and biscuits for healthier alternatives such as fruit,nuts and seeds
• avoid sugary drinks sugar-free or diet drinks are better than sugary versions; be aware that fruit juices and smoothies contain sugar, too, and so do some "no added sugar" drinks, so ensure you check the label or ask your health care team
• includelean not fattysources of protein in your diet, such as fish

It's also important to be aware of foods all pregnant women should avoid , such as certain types of fish and cheese.

Diabetes UK has more information about diet and lifestyle with gestational diabetes .

Exercise

Physical activity lowers your blood glucose level, so regular exercise can be an effective way to manage gestational diabetes.

You'll be advised aboutsafe ways to exercise during pregnancy.Read about exercise in pregnancy for more information.

A common recommendation is to aim for at least 150 minutes (2 hours and 30 minutes) of moderate intensity activity a week.

This is any activity that raises your heart rate and makes you breathe faster, such as brisk walking or swimming.

Medication

You may be offered medication if your blood sugar level is not under control a week or two after changing your diet and exercising regularly, or if your blood sugar is very high. This may be tablets usually metforminor insulin injections.

Your blood sugar level can increase as your pregnancy progresses, so even if your blood glucose levels are well controlled at first, you may need to take medication later in pregnancy.

These medications will be stopped after you give birth.

Tablets

Metformin istaken as a tablet up to three times a day, usually with or after meals.

Side effects of metformin can include:

• feeling sick
• vomiting
• stomach cramps
• Traveller's diarrhoea
• loss of appetite

Occasionally a different tablet called glibenclamide may be used.

Insulin injections

Insulin may be recommended if:

• you can't take metformin or it causes side effects
• your blood sugar level isn't controlled with metformin
• you have very high blood sugar
• your baby is very large or you have too much fluid in your womb (polyhydramnios)

Insulin is taken as an injection, which you'll be shown how to do yourself. Depending on the type of insulin you're prescribed, you may need to inject yourself before meals, at bedtime, or on waking.

You will be told how much insulin to take. Blood sugar levels usually increase as pregnancy progresses, so your insulin dose may need to be increased over time.

Insulin can cause your blood sugar to fall too low (hypoglycaemia) . Symptoms of low blood sugar include feeling shaky, sweaty, hungry, turning pale, or finding it difficult to concentrate.

If this happens, you should test your blood sugartreat it straight away if it's low. Find out how to treat low blood sugar .

You'll be given information about hypoglycaemia if you're started on insulin.

Monitoring your pregnancy

Gestational diabetes can increase the risk of your baby developing problems, such as growing larger than usual.

Because of this, you'll be offered extra antenatal appointments soyour baby can be closely monitored.

Appointments you should be offered include:

• an ultrasound scan at around weeks 18-20 of your pregnancyto check your baby for abnormalities
• ultrasound scans at weeks 28, 32 and 36to monitor your baby's growth and the amount of amniotic fluid, and regular checks from week 38

Giving birth

The ideal time to give birth if you have gestational diabetes is usually around weeks 38 to 40.

If your blood sugar is within normal levels and there are no concerns about your or your baby's health, you may be able to wait for labour to start naturally.

But you'll usually be offered induction of labour or a caesarean section if you haven't given birth by 40 weeks and 6 days.

Earlier delivery may be recommended if there are concerns about your or your baby's health, or if your blood sugar levels haven't been well controlled.

You should give birth at a hospital where health care professionals are available to provide appropriate care for your baby 24 hours a day.

When you go into hospital to give birth, bring your blood sugar testing kit and any medications you're taking with you.

Usually you should keep testing your blood sugar and taking your medications until you're in established labour or you're told to stop eating before a caesarean section.

During labour and the birth, your blood glucose will be monitored and kept under control. Some women may need a drip of insulin to control their blood sugar levels.

After birth

You can usually see, hold and feed your baby soon after you've given birth.It's important to feed your baby as soon as possible after birth (within 30 minutes) and then at frequent intervals (every 2-3 hours) until your baby's blood sugars are stable.

Your baby's blood sugar level will be tested starting two to four hours after birth. If it's low, your baby may need to be temporarily fed through a tube or a drip.

If your baby is unwell or needs close monitoring, they may be looked after in a specialist neonatal unit.

Any medication you were on to control your blood sugar will usually be stopped when you give birth.You'll usually be advised to keep checking your blood sugar for one or two days after you give birth.

If you're both well, you and your baby will normally be able to go home after 24 hours.

You should have a blood test to check for diabetes 6 to 13 weeks after giving birth. This is because a small number of women with gestational diabetes continue to have raised blood sugar after pregnancy.

If the result is normal, you'll usually be advised to have an annual test for diabetes. This is because you're at an increased risk of developing type 2 diabetes a lifelong type of diabetesif you've had gestational diabetes.