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Diabetes in pregnancy

Our diabetes clinic supports pregnant women and people who have diabetes in pregnancy. This includes if you:

  • have type 1 or type 2 diabetes
  • had gestational diabetes in a previous pregnancy
  • or if you develop gestational diabetes in your pregnancy.

If you had diabetes before your pregnancy

If you have type 1 or 2 diabetes, you will have your booking (first) appointment with the Maternal Medicine team. They are a long-established team who have excellent links with the wider diabetes team.

We will offer you appointments in the pregnancy diabetes clinic. This runs each Tuesday in the Venetian Building. You will have access to diabetes doctors, specialist nurses, dietitians, obstetric doctors (specialists in pregnancy) and to your midwifery team. This means you do not need to attend multiple appointments to see different specialists.

Managing your diabetes may become more difficult during pregnancy, due to changing hormone levels. To help with this, if you use a continuous blood sugar monitor, we offer phone or email reviews of your blood sugar levels. This will help to monitor your blood sugar levels while reducing your number of hospital visits.

Gestational diabetes

Gestational diabetes is a type of diabetes that occurs in pregnancy. It happens because the placenta produces hormones that can interfere with the body’s ability to use insulin. Insulin controls your blood sugar levels, and changes to it can cause your blood sugar levels to rise.

Gestational diabetes usually occurs in the second or third trimester. While it can increase some risks to you and your baby, most women with gestational diabetes are able to manage their condition through diet, exercise, and sometimes medication, and to have a healthy pregnancy and baby. Assessment and screening are essential for detecting the condition early and managing it well.

Risks

If you have gestational diabetes, your baby may have a large birth weight (macrosomia). This increases the risk of injury during birth, and of low blood sugar levels in the baby after birth.

Having gestational diabetes also means you are more likely to develop type 2 diabetes later in life.

Assessment and testing

At your first midwife booking appointment, we will assess how likely you are to develop gestational diabetes. It is more likely if you:

  • have a body mass index (BMI) over 30
  • previously had a large baby – over 4.5kgs (10lb) at birth
  • have had gestational diabetes before
  • have a close relative with diabetes
  • are of south Asian, Black, African-Caribbean or Middle Eastern origin
  • have high sugar levels in your urine
  • or you have polycystic ovarian syndrome.

If you have a high chance of gestational diabetes but do not want to take these tests, please speak to your midwife. They may be able to offer you an alternative.

HbA1c blood test

If you have a higher chance of developing gestational diabetes, we will offer you a blood test called a HbA1c at your booking appointment. This shows how much sugar has been in your bloodstream in the last 12 weeks. If there has been a high amount of sugar, we can then diagnose gestational diabetes.

Glucose tolerance test (GTT)

If your HbA1c blood test is normal, we will offer you a glucose tolerance test (GTT) when you are 28 weeks pregnant. This is sometimes called an oral glucose tolerance test (OGTT). It measures how well your body processes sugar (glucose).

Please do not bring children to your glucose tolerance test. If you have any questions, we advise you to ask your midwife.

  • The night before your test, you will need to fast (not eat anything, and only drink water) from 10pm onwards.
  • When you arrive, you will have a blood test to measure your blood sugar level after fasting.
  • You will then be given a sugary drink. You’ll be asked to drink it in a certain amount of time, usually 5 minutes.
  • Two to three hours after you finish the drink, you will have another blood test.
  • The two blood tests are compared, to show how your body is handling the sugary drink.

Phone: 0203 299 7060

Location: Stork on the Hill Midwifery Centre, Blachedowne, London SE5 8HL

Diagnosis and care

If your tests show you have gestational diabetes, a Diabetes midwive will call you. They will:

  • explain what your diagnosis means for you and your pregnancy
  • arrange an online appointment with a dietitian, to support you in making choices about what you eat
  • discuss how best to test your blood sugar levels during your pregnancy.

We know that finding out you have gestational diabetes can be worrying, and we are here to support you. We have many years’ experience supporting families through pregnancy. We encourage you to discuss any questions or concerns with us.

Gestational diabetes can vary from mild to more severe. If your condition is mild, we may suggest you staying with your original community midwife team for your pregnancy care, and we monitor your blood sugar levels remotely, by phone or email. If you need medication or extra support to help you manage your gestational diabetes, the maternal medicine team will provide your midwifery care.

We aim to manage your diabetes without admitting you to hospital. This may involve frequent monitoring appointments, which we will discuss with you.

Clinic details

Giving birth

We will support you to make choices about your pregnancy care, and offer advice and guidance about giving birth.

Based on your unique circumstances, we will recommend the best date for giving birth. If your baby’s growth progresses as expected and your blood sugar levels are stable, we recommend delivering before 40 weeks and 6 days.

We may suggest an earlier delivery if this will the lower risk to you or your baby during the birth. To decide this, we will look at your ultrasound scans and blood sugar control.

Typically, we do not recommend giving birth before 38 weeks of pregnancy.

If your labour has not started naturally by the date we recommend, we may suggest:

  • Induction of labour. This is when labour is started artificially.
  • a planned caesarean section – an operation to deliver your baby through a cut made in your abdomen and womb.

Recommended resources

NHS information on diabetes and pregnancy

NHS information on gestational diabetes

Diabetes UK gestational diabetes webpage