During your pregnancy the doctors, midwives, dietitians and diabetes educators will provide information about how diabetes will affect some parts of your care.
This web page will provide some information to guide you through a few questions you may already have.
Please ask us at your visits if you don't understand or need some more information.
If you have GDM, we welcome you to take part in research to help us improve our service. A Participant information sheet is available via this link. You may be invited to fill in a survey for us when your baby is about 6 weeks old. To make sure you don't miss out, please click here to send your name, expected date of birth and phone number to a researcher.
There are different forms of diabetes that affect some women during pregnancy: Type 1, Type 2 and Gestational diabetes (GDM).
Having diabetes in your pregnancy means that you need to have a few extra visits to the hospital clinics and the Illawarra Shoalhaven Diabetes Services to manage your blood glucose levels and look after baby as they grow.
Type 1 and Type 2 Diabetes are forms of diabetes that you may already know you have. You may already be seeing an endocrinologist and they can continue to be involved in your care.
Gestational Diabetes Mellitus (GDM) is a form of diabetes that affects some women during pregnancy and usually goes away after the baby is born.
Sometimes GDM can be controlled by your diet and sometimes you will need medication such as insulin to help you control your blood glucose (sugar) levels.
It is diagnosed when higher than normal blood glucose levels (BGL's) first appear during pregnancy.
The National Diabetes Services Scheme (NDSS) has some great information about diabetes and it is also available in different languages:
How is diabetes in pregnancy diagnosed?
All women are screened for diabetes in their pregnancy
If you are at risk for diabetes in pregnancy (see list in section above), you will have a blood test early in your pregnancy.
If that test is negative, you will be screened again with all other pregnant women with an oral glucose tolerance test (GTT) between 24 and 28 weeks of pregnancy
If you have been diagnosed, you will need to monitor your blood glucose levels and diet You may also require medication such as insulin.
The Illawarra Shoalhaven Diabetes Service will talk to you about how best to manage your diabetes such as healthy eating, staying physically active and checking your blood glucose levels regularly.
You will also be given information for contacting staff if you have any concerns, or if your blood glucose levels are higher than the target levels given to you.
Am I at risk for developing GDM?
Your doctor will order some blood tests early in pregnancy to test for GDM.
Sometimes this will be a fasting glucose level and sometimes you may need a full GTT test.
GTT (Glucose Tolerance Test). You will have a fasting blood glucose taken and after a sweet drink your blood glucose levels will be checked at 1 hour and 2 hours after the drink.
Most women have this test at about 28 weeks of pregnancy.
However, if you have risk factors for GDM (see list below), you will be tested early in your pregnancy, If your early pregnancy test is negative for GDM, you will be tested again at 28 weeks gestation.
Risk factors for GDM:
- Previous hyperglycaemia (high blood glucose levels) in pregnancy
- Previously elevated blood glucose level
- Maternal age ≥40 years
- Ethnicity: Asian, Indian subcontinent, Aboriginal, Torres Strait Islander, Pacific Islander, Maori, Middle Eastern, non-white African
- Family history diabetes (1st degree relative with diabetes or a sister with hyperglycaemia in pregnancy)
- Are above the healthy weight range
- Previous macrosomia (baby with birth weight > 4500 g or > 90th centile)
- Polycystic ovarian syndrome
- Medications: corticosteroids, antipsychotics
For more information, click here to access the Diabetes Australia website
What happens if I have GDM?
GDM is one of the most common medical issues during pregnancy. It can be managed through lifestyle changes, although one in three women may require insulin to help manage their blood glucose levels.
Your GP or the hospital will refer you to the Illawarra Shoalhaven Diabetes Services if you have been diagnosed with GDM.
You can keep visiting your GP or midwife for pregnancy visits if you keep your blood sugar/glucose levels (BGLs) within the limits set by the Illawarra Diabetes Service (IDS). This can be done by watching what you eat. The IDS dieticians will help you with this.
The Illawarra Shoalhaven Diabetes Service will talk to you about how best to manage your diabetes such as healthy eating, staying physically active and checking your blood glucose levels.
Keeping your blood glucose levels stable looks after the health of both you and your baby.
You will be given a book to record your blood glucose levels (BGL's). You should contact the diabetes educators if you have 2 or more elevated BGL's in a week.
Your midwife or doctor, and the IDS team will ask about your BGL's throughout your pregnancy. Routine appointments (a combination of phone, email and face-to-face) will be made to review your GDM until your baby is born.
Phone the Illawarra Shoalhaven Diabetes Service on 1300 308 969 to book your appointment
Illawarra Shoalhaven Diabetes Service website
Staff may also talk about expressing and collecting colostrum in the last few weeks of your pregnancy if it is safe to do so. There is more information and a video about antenatal hand expressing in the next section.
Birth
While you are in labour a Midwife will check your BGLs until you have your baby.
If you are booked for an elective caesarean section, a Midwife will check your BGL before you go to the operating theatre.
Baby's BGLs
You and your baby will be transferred to the Maternity ward together for a minimum 24-hour stay
Baby's BGL's will be checked 30 minutes after their very first feed, or 1 hour from birth (whichever comes first). It is important that you feed baby often during this time to help keep their levels up. You could also give baby colostrum (expressed before baby was born) - see next section for more information.
Midwives on the ward (C2West) check baby's BGLs before the next 3 feeds (aiming for a BGL 2.6mmol/L or more). If baby's BGL's are low, your baby may be transferred to the Neonatal or Special Care Unit to be seen by the paediatrician.
More information about GDM, hormones, blood glucose (sugar) levels and breastfeeding is in this presentation below:
Do I still have GDM after baby is born?
GDM -
Once the baby is born most women can go back to a more normal life, no more blood sugar levels! Your doctor will advise you when to stop testing your BGL's.
More formal blood glucose testing is recommended 6-12 weeks after baby is born to make sure your diabetes was just caused by your pregnancy
As many as one in every two women who have had GDM will develop pre-diabetes or Type 2 diabetes within 10-20 years (NDSS).
Your baby also has a higher risk of developing GDM (if they are a girl) and Type 2 diabetes later in life. You can reduce this risk by breastfeeding:
- Research is showing that women who breastfeed their babies are less likely to develop Type 2 diabetes later in life
- Breastfeeding also has a protective effect for babies developing diabetes later in life (including Type 1 diabetes)
- Breastfeeding may also reduce your risk of getting gestational diabetes in your next pregnancy
We may suggest you express your colostrum in the last few weeks of pregnancy to feed to your baby when they are born to help reduce these risks (and for the many other benefits colostrum has for your baby) - see Hand Expressing below or click on this link for more information. Your midwife or doctor can let you know if this is safe for you to do and provide the collection kit and education.
More information about GDM can be found on the NDSS site here
What happens to baby after birth?
When your baby is first born their blood glucose levels (BGL) will be checked regularly. At birth, their BGL will be very much the same as the mother, but within the first hour the level starts to drop.
Baby’s BGL's will be checked from a prick on the baby’s heel and using a similar machine to the one you have used during pregnancy. Our aim is to keep the baby’s blood glucose from dropping below 2.6mmol/L.
You and your baby will be in the Maternity ward together for at least 24-hours. Baby's BGL's will be checked 30 minutes after their very first feed, or 1 hour from birth (whichever comes first) and then before the next 3 feeds.
If baby's BGL's are low, your baby may be transferred to the Neonatal or Special Care Unit to be seen by the paediatrician.
Some ways to keep baby's BGL stable:
- Immediate skin to skin with the mother, for at least an hour, keeping the baby warm
- Having their first breast feed within the first hour (ideally within 30 minutes)
- Giving the baby some extra colostrum (the first, immune protecting breast milk) can help if they are not ready to feed
- Feed your baby at least every 3 hours, more frequently if BGL's are low
Is breastfeeding important for me?
When you have diabetes in pregnancy, there is a higher risk for baby to develop diabetes in their lifetime. If you have GDM, there is also a higher risk for you developing Type 2 diabetes in the next 5-20 years. Breastfeeding can reduce these risks for both mothers and their babies.
Some mothers choose to express some of their colostrum in the last 2-3 weeks of pregnancy to help stabilize baby's blood sugar levels after birth. Please see "Antenatal HAND EXPRESSING of breastmilk (colostrum) from 36 weeks of pregnancy" tab below for more information.
More information about GDM, blood glucose (sugar) levels, hormones and breastfeeding is in this presentation below:
Antenatal HAND EXPRESSING of breastmilk (colostrum) from 36 weeks of pregnancy
You may be encouraged to express your milk from 36 weeks of pregnancy to have a small store of milk available for your baby when he/she is born.
Please remember, it is very normal for you to only get very small amounts of colostrum (sometimes only a drop), but every drop helps! The amount of milk you make while you are pregnant does not predict the amount you will make for your baby after it is born.
Watch our video below to see how hand expressing is done while you are pregnant.
Midwives at the hospital can give you all of the equipment you need and instruction.
We have an on-line education class every Monday 1-2pm. Call the antenatal clinic at Wollongong Hospital to book in: Ph. 4253 4256 or 4253 4284.
We have midwives and a lactation consultant available to help you if you would like to talk to someone.
Tips to remember:
- Most women who have diabetes can begin expressing colostrum
- As long as there are no risk factors, such as a history of pre-term labour or birth, this can start at 36 weeks gestation
- Very small amounts of the colostrum will be stored in syringes and frozen, then brought into the hospital on the day baby will be born
- Some women will get up to 1ml, some women get just a few drops, others none at all – this is more to do with the pregnancy hormones that the ability to be able to breastfeed the baby
- each syringe should have you name and the date and time the colostrum was expressed - your hospital patient labels are good to use for this
- Antenatal expressing is always done using hand expressing (a breast pump will not work with the tiny amounts you get in pregnancy)
- The video above will provide more information on hand expressing. Your midwife can also show you or answer any questions you might have.
- The hospital will provide a kit which contains an information sheet, syringes with caps, and some little cups to help catch the drops.
- The kit will come in a plastic bag to store syringes in the freezer.
- Try to aim for 0.5 to 1ml in each syringe – if much less than that is expressed, the same syringe can be used over the rest of the day, putting the cap on and storing in the fridge in between expressing (one syringe for every 24 hours, with the time recorded that of the first session of the day)
- Don’t be disappointed if there is only a very small amount collected, still freeze and bring to the hospital, it can still be used
- On the day baby is to be born or labour starts put the bag with any syringes into a lunch box with an ice brick to keep cold and frozen and bring to the hospital
- Your midwife will place it in the freezer to keep if baby’s blood sugars are low or if baby needs a little extra
- If your baby is going to arrive before, or around, 36 weeks your midwife can help you to collect some colostrum when you are admitted to hospital
- remember to do lots of skin to skin and frequent breastfeeding once your baby has arrived to keep their BGL's stable
Breastfeeding support before and after baby & The Milky Way App
During your pregnancy -
- A virtual breastfeeding education group runs every Friday from 1 - 2 pm
- Discuss booking into this class with your midwife or Antenatal Clinic staff
- This is for all parents, whether you are a first timer or you need a refresher
- Both parents are welcome to attend from the comfort of your own home using your phone, computer or tablet
After discharge with baby -
- Most women will have a midwife from the hospital follow you up at home after discharge to help with feeding and your after birth care
- A Child and Family Health nurse will contact you after discharge to make an appointment with them - they are very skilled in infant and young child feeding
- After birth breastfeeding education groups - ask your Child and Family nurse for more information or go to their Facebook group https://www.facebook.com/ChildandFamilyHealthISLHD
- Your midwife or nurse may refer you to a Family Care Centre for extra breastfeeding support
- The Australian Breastfeeding Association - Breastfeeding Helpline 24 hours a day, to speak to a counsellor and get some advice call 1800 686 268
- You could also look for a private Lactation Consultant (IBCLC) through LCANZ - https://www.lcanz.org/find-a-lactation-consultant/
The Milky Way Breastfeeding App
Care at your hospital
Your pregnancy care can be with your GP, or through the hospital based midwife or doctor clinics at your local hospital. You will also be closely supported by the dietitians and diabetes educators at ISDS (Illawarra Shoalhaven Diabetes Service) who work closely with your pregnancy team at the hospital you receive your care.
Shoalhaven and Milton-Ulladulla Hospital
Your MAPS (Maternal Antenatal and Postnatal Service) midwife will talk to you about what happens with your labour and birth. The midwife will explain blood glucose monitoring during labour and also after birth for you and your baby.
The MAPS midwives will support you to understand if you should collect colostrum in the last few weeks of pregnancy, and show you how to do this and give you the equipment you need to express and store it.
You can also be referred to the lactation consultant if you have any more questions or concerns.
If your blood glucose levels are above the recommended targets (3 or more times in a week), please call the dietitian on 4424 6304
Wollongong Hospital
Wollongong Hospital also runs an on-line GDM-midwife session every month on a Monday from 1-2 pm.
The midwife will talk to you about what happens for you and your baby when you birth. She will also explain blood glucose monitoring in labour and after birth for you and your baby. She will also tell you about expressing colostrum in the last few weeks of pregnancy to bring to the hospital for your baby when they are born. They will also tell you how to get the expressing and storing kit at your next hospital visit.
After you have booked in, a text message will be sent to you before the session with details of how to log in.
Call the Antenatal Clinic at Wollongong Hospital to book in to this on-line information session on:
Ph 4253 4256 or 4253 4284
If your blood glucose levels are above the recommended targets (3 or more times in a week), please call the dietitian on 42311920.
What are TARGET levels?
To help manage your diabetes in pregnancy, the diabetes educators, dietitians and your midwife or doctor will work with you to help keep your blood glucose levels (BGL) within TARGET levels.
Your diabetes team will let you know what YOUR own target BGL levels are and how often to check them. (They will also show you how to do it and make sure you have all of the equipment you need)
Your targets may be slightly different from your friend's levels depending on how your diabetes is managed (e.g. diet or with medicine), and the hospital you attend (e.g. in one hospital we may look at your BGL level one hour after eating food and another hospital may like you to check 2 hours after you eat). All of these are accurate ways of measuring your BGLs for diabetes management.
The important thing to remember is that if YOUR BGL level is higher than YOUR target level 3 or more times in the week, please call the diabetes team (diabetes educator or dietitian - see below).
As a guide, here are some examples - ring the diabetes educator or dietitian if YOUR BGL levels are above these targets:
Calling a diabetes educator or dietitian
The Illawarra Shoalhaven Diabetes Service will talk to you about how best to manage your diabetes such as healthy eating, staying physically active and checking your blood glucose levels.
The diabetes team will regularly look at your BGL's throughout your pregnancy. Routine appointments (a combination of phone, email and face-to-face) will be made to review your GDM until your baby is born.
Target levels for your BGLs will be advised by your diabetes team.
If your levels are above the targets you have been given, 3 or more times in a week, please call the dietitian -
at Wollongong on 4231 1920
or in the Shoalhaven on 4424 6304
What to eat until you see a Dietitian
Need an Interpreter? Professional interpreters are available if you need help to communicate with staff. Our staff can also ask for an interpreter. The service is free and confidential. We will book the interpreter for you. You can also call the Translating and Interpreting Service on 131 450 if you need to speak to us before your appointment. Click here for more information about the Illawarra Health Care Interpreter Service.