Diabetes and Pregnancy
Gestational Diabetes. What does this mean for me?
This week is National Diabetes Week in Australia.
Everyone knows someone who has or will have diabetes. In Tasmania there are over 25,000 people who live with diabetes.
Type 1 diabetes mellitus (T1DM) is more common in childhood and early adulthood. Type 1 diabetes can be inherited, but can also arise for the first time with no family history. A healthy lifestyle and diet, insulin injections or insulin pump are the main treatments.
Type 2 diabetes mellitus (T2DM) is more common as we get older. This is now the commonest type of diabetes. Family history (which none of us can escape) and obesity remain the two leading risk factors. A healthy lifestyle and diet, oral tablets and less commonly insulin, are the mainstays of treatment.
Gestational Diabetes Mellitus (GDM) is diabetes of pregnancy. This is usually diagnosed at 24-28 weeks of pregnancy with an oral glucose tolerance test (OGTT), and is seen in 10-15% of pregnancies. Not all women who develop GDM have risk factors (such as obesity, family history, previous GDM or age over 40 years), although these make the condition more likely. Once again, a healthy lifestyle and diet, oral tablets and sometimes insulin, are the main treatments.
Women with diabetes in pregnancy (T1DM, T2DM and GDM) all require a team approach to managing both their diabetes and their pregnancy. The team usually includes the woman and her family supports, her obstetrician, endocrinologist, diabetes educator, dietician and psychologist. Others may be required if the pregnancy or diabetes develops complications.
At TasOGS, as obstetricians who frequently manage women with diabetes in pregnancy we are aware of the different ways in which the different types of diabetes can affect mother, pregnancy and baby.
Extra attention is required to monitor pregnancies involving diabetes as they can have higher rates of complications. These include greater risk of miscarriage, blood pressure problems, risk of both extremely small and extremely large babies, higher rates of early birth, higher caesarean section need, risks of antenatal and postnatal depression, and higher rates of admission of newborn babies to the neonatal nursery.
Pregnancy can also accelerate some of the general complications of diabetes. Knowing this we encourage all women with diabetes to first discuss pregnancy planning with their GP, endocrinologist, or high-risk obstetrician before getting pregnant.
Diabetes is common. In pregnancy diabetes challenges both a women’s physical and psychological wellbeing, as well the wellbeing of her baby and birth experience. Understanding and support is one way to improve this experience for all.
We encourage your support of Diabetes Australia to enable further research in diabetes prevention, treatment and cure.
Dr Kirsten Connan has a strong interest in obstetric medicine and completed a year of Maternal Fetal Medicine Training (High Risk Obstetrics) in 2010 at the Royal Women’s Hospital, Melbourne.
Dr Connan has worked in the Pregnancy Diabetes clinic at the Royal Women’s Hospital, Melbourne, Royal Darwin Hospital and was the Obstetric Lead at the Pregnancy Diabetes clinic in 2015 during her time at the Royal Hobart Hospital.