During pregnancy your midwife or doctor will be checking to ensure that your baby is growing well. This is done at defined stages in the pregnancy, either by measuring your bump with a tape measure or by routine ultrasound scans. If there is a concern about the growth of your bump you may be referred for a growth scan. Your baby’s progress is plotted on a chart by the person taking the measurement (midwife, doctor or sonographer).If your baby is found to be growing smaller than expected you may require additional ultrasound scans and antenatal appointments to monitor your baby’s wellbeing.
Group B Streptococcus (GBS): Frequently asked questions
How is the diagnosis made?
Group B streptococcus (GBS) is a bacterium that lives in the body and causes no harm to you; it can cause a serious infection in a baby around the time of birth. GBS is carried in the vagina or rectum of up to 40% of women. It can be found on a vaginal or rectal swab or a urine test. In the UK there is no current screening programme for the carriage of GBS.
What does this mean?
For me:
If you are found to carry GBS in your current pregnancy you will be recommended to receive intravenous antibiotics during labour, to minimise the chance of your baby developing a GBS infection.If GBS is found in your urine during pregnancy, you should receive antibiotic treatment.
For my baby:
Most babies that come into contact with GBS during birth are well and do not develop GBS infection. If a baby does show signs of GBS infection, with prompt treatment most babies will recover completely. Rarely, GBS infection can be the cause of a neonatal death or longer term disability.
What will the medical team recommend?
Intravenous antibiotic prophylaxis (IAP) for you during labour. If there are any concerns about your baby after birth, the neonatal team may recommend they receive antibiotics as well.
What are the ‘red flag’ symptoms/concerns, which mean that they should be reported immediately?
If you are known to carry GBS, you should inform your maternity unit straight away when your waters break, or if you are having regular labour pains.
Timing of birth
If your pregnancy progresses to term (after 37+0 weeks) IAP should be commenced as soon as labour starts or when your waters break, if they do so before labour.If your waters break before labour, induction of labour will be recommended to reduce the time your baby is exposed to the GBS bacteria.
How may this impact my birth choices?
IAP is not available at home, or in some midwifery led units, so if you agree with the recommendation to receive IAP you may need to plan labour and birth in an obstetric unit.
How may this affect care after the birth?
Depending on how long your receive IAP for before your baby is born, your baby may need some additional observation in hospital before you are able to go home.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
In a future pregnancy you will be offered IAP again in labour, or testing for GBS carriage 3-5 weeks before birth is expected.
Where can I find out more information about this condition?
Most people with Lupus can safely get pregnant and with appropriate support and care can have normal pregnancies and healthy babies. However, pregnancy with SLE carries a higher risk to mother and baby compared with pregnancy in women with no medical concerns. For this reason, your maternity team will consider such pregnancy as ‘high risk” to ensure that care is appropriate for your clinical condition and involves several healthcare professionals.We recommend that you access the BUMPS website (Best Use of Medicines in Pregnancy), for information and advice relating to medications taken prior to and during pregnancy. It is important not to stop any medication before checking with your doctor as this may be harmful to you or your baby.
What does this mean for my pregnancy?
For me:
In general, pregnancy does not cause flares (worsening) of SLE, but higher risk of flares is noted in women who have had flares within the six months prior to pregnancy, have had very active disease, or if SLE treatment has been stopped. If flares happen, they often occur during first or second trimester of pregnancy or in the first few months after the birth.It is vital to report flares promptly as they increase the risk of complications. Complications can include pre-eclampsia, blood clot in deep veins or lung, severe infection, and stroke.
For my baby
SLE in pregnancy increases the risk of miscarriage, preterm birth, slower growth in the womb (intrauterine growth restriction) and stillbirth, compared to a woman with no medical concerns. Factors such as previous miscarriage, antiphospholipid syndrome, active Lupus before or during pregnancy, kidney disease and pre-eclampsia increase this risk.Your blood tests will include checking your antibodies status for anti-Ro and anti-La antibodies. If these are present, there is a small chance these antibodies may cross the placenta and therefore could affect the baby causing a 2% risk of congenital heart block and 5% risk of cutaneous neonatal lupus (where certain antibodies cross from mother to baby). However, having neonatal Lupus does not appear to increase the chance of your baby developing SLE in adult life.
What will the medical team recommend?
The aim will be to personalise the care to you and your clinical condition. You will be seen more frequently in a specialist consultant-led maternal medicine antenatal clinic and offered regular scans to monitor baby’s growth, alongside the care provided by your midwifery team.If you have Ro and La antibodies, the team will organise a specialist heart scan for your baby (echocardiogram).You will be advised to take 75mg of aspirin each night from 12 weeks until 36 weeks to reduce your risk of pre-eclampsia. You may require calcium supplementation. Since there is an increased risk of developing a blood clot (thrombosis) you may be advised to take additional medication such as blood-thinning injections.Other medical treatment will be tailored according to your disease severity and will be discussed in detail by your clinical team.
What tests will/may be considered? How often may they be needed?
At the start of pregnancy, baseline blood tests will also include kidney and liver function tests, antibody tests like anti-Ro and La antibodies, if these haven’t been done previously, and other disease relevant tests. Urine will be tested for protein. Based on your past medical history, other tests like echocardiogram, lung function test may be considered. If you are at risk of Vitamin D deficiency, these levels will be also be checked.Throughout the pregnancy, your blood pressure, urine protein levels and blood results will be closely monitored. More frequent blood pressure and urine checks will happen if you have hypertension, pre-eclampsia and/ or renal disease.
What symptoms and signs should I be looking out for?
Differentiating between pregnancy-related symptoms and those of SLE can be difficult. You may notice a range of changes throughout pregnancy that may be unrelated to your SLE, but it is important to mention any symptoms that are worrying you.You must try and avoid triggers that you may know can set off your flare ups.
What are the symptoms/concerns, which mean that they should be reported immediately?
Flares of SLE is when your symptoms worsen and make you feel unwell. Often, this involves symptoms you have noticed previously, and some people may also develop new symptoms. Common symptoms that indicate a flare include raised body temperature not due to an infection, painful and swollen joints, increase in tiredness, rashes, ulcers in your mouth or nose and increased swelling of your legs.You should also immediately report symptoms like shortness of breath, chest pain, heart palpitations, painful swollen calf, feeling unwell; severe headache, seeing flashing lights or experiencing pain in upper tummy, contractions, vaginal bleeding, rupture of membranes or reduced baby movements.
How are recommendations made regarding my care?
Treatment options
There are overarching guiding principles on the use of medications during pregnancy and breast feeding. Based on the individual clinical condition medications will vary. In general, SLE medications that are safe in pregnancy, during breast feeding and required to maintain remission and/or treat flares include hydrochloroquine, azathioprine, cyclosporine and tacrolimus. Aspirin and paracetamol are safe in pregnancy. Corticosteroids are safe to control active disease.Medications to control high blood pressure may become necessary.
Timing of birth
People with SLE are more likely to have a preterm birth, that is birth before 37 weeks. The risk is particularly increased in the presence of active Lupus, kidney disease, hypertension and pre-eclampsia. Birth may start spontaneously or may be induced due to concerns relating to your or your baby’s health.Your team will discuss the timing of birth with you, considering your and your baby’s health.
How may this impact my birth choices?
For most people with SLE vaginal birth should be possible, but choices will be influenced by how this pregnancy progresses, your previous births and other possible concerns.Discuss your personal birth preferences with the team.
How may this affect care after the birth?
Your team should make a care plan with you relating to your and your baby’s care after the birth.You will be given guidance on medications that need to continue and will be safe to take whilst breastfeeding. There is an increased risk of SLE flare after the birth and you must report these immediately so that the medications can be adjusted.You will require blood thinning medications as the risk of blood clots increases significantly after the birth. These may need to continue for up to six weeks after the birth.
What will this mean for future pregnancies?
It is important to plan all future pregnancies to improve your chances of a successful pregnancy. It is advisable to wait a year before trying for another baby and to conceive when your SLE has been inactive for at least six months on treatment. You must see your doctor, three to six months before you plan to start trying for a pregnancy to enable a full health assessment and medication plan. Use contraceptives till you are ready to try for another pregnancy.
Ulcerative Colitis and Inflammatory Bowel Disease (IBD): Frequently asked questions
How is the diagnosis made? This was made before pregnancy. All women with IBD, Crohn’s Disease or Ulcerative Colitis should receive preconception counselling to optimise their health before pregnancy.
What does this mean?
For me:
You are at risk of preterm delivery and developing flares (worsening) of your symptoms. You may need to attend more hospital visits during pregnancy. You are at higher risk developing of pre-eclampsia.
For my baby:
Your baby is at risk of preterm delivery.
What will the medical team recommend?
You will be seen more frequently in a specialist consultant-led maternal medicine antenatal clinic.
What tests will/may be considered? How often may they be needed?
You may need further tests if your symptoms worsen.
What symptoms and signs should I be looking out for?
Abdominal pain, blood and/or mucus in your stool or increased frequency of passing stool (poo).
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you have a worsening (flare) of your symptoms.
How are recommendations made regarding treatment options?
Most of the drugs used are safe during pregnancy. You may be on special medication (known as a biologic) for your condition. If you require these during the third trimester of pregnancy you will need to delay giving your baby live vaccines, this includes the BCG and rota virus until six months after birth. Be sure to discuss this with your medical team after the birth of your baby.
How are recommendations made regarding timing of birth?
By 36 weeks your team should be working with you to plan your delivery.
How may this impact my birth choices?
If you have had previous operation for your condition you may need to birth your baby by caesarean-section.
How may this affect care after the birth?
A birth plan prior to delivery should have been agreed to ensure you are on medication that are safe to use during breastfeeding. Your medication may need to be increased or changed if your symptoms worsen after birth.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Optimise your health and your symptoms between pregnancies.What will this mean for future/ my long-term health and how can I influence this?Contraception and a follow up plan should be made to optimise your health for future pregnancies.
Intrahepatic Cholestasis of Pregnancy (OC): Frequently asked questions
How is the diagnosis made?
If you have itching without a rash in your pregnancy, then you will have blood tests including a liver function and bile acid level. Raised bile acids will confirm the diagnosis of Intrahepatic Cholestasis of Pregnancy (ICP) which is also known as Obstetric Cholestasis (OC).
What does this mean?
For me
You may have severe itching, often starting on the hands and feet but can affect anywhere on your body. Your doctor can give you medication to calm the itching sensation but it will not disappear until you have given birth.
For my baby
If the bile acids are very high (greater than 100) then there is an increased risk of the baby passing away whilst in the womb, so it is really important that the level of bile acids are monitored every week once the diagnosis is made or as long as you have itching.
What will the medical team recommend?
Your medical team will recommend weekly blood tests at least weekly whilst you have symptoms of itching, and once you have a diagnosis of ICP.
What tests will/may be considered? How often may they be needed?
Blood tests for your liver function and the concentration of bile acids in your blood will be checked regularly.
What symptoms and signs should I be looking out for?
Itching in pregnancy without a rash, particularly if it occurs on the palms of your hands or the soles of your feet.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If your baby isn’t moving like normal, then you should be seen at the hospital immediately.
Likely recomendations
Treatment options
If your bile acids are more than 40 mmol/L, then your doctor may recommend treatment with ursodeoxycholic acid or, in severe cases, other medication such as rifampicin. Your itching can be treated with antihistamine tablets and menthol skin creams. Your medical team will provide a prescription if these medications are recommended to you.
Timing of birth
This will depend on the level of your bile acids but would normally be after 38 weeks if the bile acids are less than 100 mmol/L, and around 36 weeks if your Bile Acids are 100 mmol/L or higher.
How may this affect my birth choices?
Continuous monitoring of your baby’s heartbeat in labour will be recommended whether you labour starts naturally or you are are induced, this is because ICP can affect your baby’s heart function.
How may this affect care after the birth?
If you have had abnormal liver function, you will need to see your GP to retest your liver function levels to ensure they have returned to normal.Your baby will be reviewed by a baby doctor after birth to ensure all is well.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
There is around 50% chance of having ICP in a subsequent pregnancy so you will be asked to keep a close eye out for symptoms of itching and your doctor may arrange some extra blood tests as part of your monitoring in pregnancy.
What will this mean for future/my long-term health and how can I influence this?
ICP does not cause long term health problems but caution is recommended before taking the combined oral contraceptive pill.There is a strong genetic link so you may want to warn your sisters and daughters as they may also be at risk of having this condition in pregnancy.
Pre-eclampsia during pregnancy: Frequently asked questions
How is the diagnosis made?
Pre-eclampsia is a condition that only occurs in pregnancy and usually after 20 weeks. It causes high blood pressure (or makes existing high blood pressure worse) and leaky kidneys with protein in the urine. The diagnosis is made based on symptoms you may experience, blood tests and urine tests.
What does this mean?
For me
The only cure for pre-eclampsia is giving birth to your baby (and placenta) but the timing of birth needs to be balanced with how unwell you and/or you baby are and what early birth would mean for your baby.You may experience headaches, blurred vision, vomiting, swelling of your hands and face or feel generally unwell. At worst, pre-eclampsia can cause kidney or liver failure, blood clotting problems and seizures.
For my baby
Pre-eclampsia affects the way the placenta works and can cause babies not to grow well in the womb and need to be born early. Babies born early may need to spend time on the Neonatal Unit to help them with breathing, feeding and temperature control. Sadly, some babies don’t survive in the womb because of pre-eclampsia.
What will the medical team recommend?
Your medical team will recommend regular checks and occasionally admission to hospital for very close monitoring. You will have regular blood tests to check your kidneys, liver and blood and your blood pressure will be monitored regularly. Extra scans of your baby will be recommended to check that they are growing well in the womb. If you develop pre-eclampsia before 37 weeks of pregnancy, then you may give birth earlier or be recommended to have labour induced at 37 weeks. If you develop pre-eclampsia after 37 weeks, induction of labour will be recommended straight away.This may be a difficult time for you and your family so it is important to have regular and open conversations with your medical team.
What tests will/may be considered? How often may they be needed?
The amount of protein in your urine will be tested alongside tests of your blood, kidney and liver function. The blood test called Placental Growth Factor that shows how well the placenta is working and helps doctors and midwives make the diagnosis of pre-eclampsia before 37 weeks.
What symptoms and signs should I be looking out for?
Headaches,swelling in your hands and face, blurred vision, pain in your tummy, vomiting, or your baby moving less than is normal.
What are the ‘red flag’ symptoms/concerns, which should be reported immediately?
If your baby isn’t moving as normal, then you should be seen at the hospital immediately.If you have any of the symptoms of pre-eclampsia listed above then you should contact your maternity unit immediately.
Likely recommendations
Treatment options
Tablet treatment for your blood pressure will be recommended if your blood pressure reading is more than or equal to 140/90 mmHgThe tablets most commonly used are:
Labetalol
Nifedipine
Methyldopa
Timing of birth
This will depend on how well you and your baby are in the pregnancy. From 37 weeks, induction of labour will be recommended as the risks of remaining pregnant for you and your baby are higher than if you give birth after this time.
How may this affect my birth choices?
Continuous monitoring of your baby’s heart beat in labour will be recommended whether you labour spontaneously or are induced, this is because the placenta may be working less well and we would not want to miss changes in the heart rate that would indicate the baby is not coping well with labour. This is available in hospital on the labour ward.
How may this affect care after the birth?
You will need to have your blood pressure checked very regularly and stay in the hospital for at least 24 hours after you give birth
Any blood pressure treatment will be switched to those suitable for breastfeeding (enalapril or amlodipine)
You may need to have magnesium and restrict how much fluid you drink
You will need to see your GP for ongoing monitoring of your blood pressure and treatment after the birth
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
High blood pressure can be reduced through diet and exercise if you are overweight or inactive.You will be advised to take aspirin in future pregnancies to reduce the risk of developing pre-eclampsia again as aspirin helps the placenta work well.
What will this mean for future/my long-term health and how can I influence this?
Pre-eclampsia increases your lifetime risk of high blood pressure four times compared to women who don’t have pre-eclampsia in their pregnancies.Your risk of high blood pressure and heart disease can be reduced by eating healthily, especially by reducing your salt intake and exercising regularly.Your risk of heart disease can also be reduced by taking your blood pressure treatment to control your blood pressure and your GP will tell you how low they would like your blood pressure to be on treatment.
You were probably diagnosed with epilepsy before you became pregnant. This condition causes seizures and these can affect the whole body with shaking and tongue biting or only affect particular parts of the body such as losing awareness and staring into space. Ideally you will have been offered pre-conception counselling to optimise your health before pregnancy.
What does this mean?
For Me
Pregnancy can lower the threshold for seizures to occur so it is important that you have care under an obstetrician specialising in medical conditions and a neurologist. You will be asked to take 5mg folic acid (ideally for three months prior to your pregnancy) to reduce the risk of disorders like spina bifida for the baby and you might need to increase your medication during pregnancy or take extra medications around the time of the birth.
For my baby
The medication called sodium valproate should not be taken in pregnancy but the other commonly used anti-epilepsy drugs are all safe to be used in pregnancy. It is really important that your epilepsy is treated effectively as frequent seizures in pregnancy can affect the baby’s growth.
What will the medical team recommend?
You may need extra blood tests to check the level of your anti-epileptic drug in your blood and to ensure you don’t need more. You will be recommended to take 5mg of folic acid to reduce the chances of your baby having a spine abnormality. You may be offered extra scans to check your baby’s growth.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
You must tell your medical team immediately if you have any seizures in your pregnancy so that they can ensure you are on the right level of treatment and organise tests to check your baby’s wellbeing.
Your partner and close family should be shown how to place you in a recovery position if you have a seizure.
The risk of seizures is greatest around the time of the birth and in the first 24 hours after the birth.
Likely recommendations
Treatment options
It is normally recommended that you stay on the same medication that you are on at the beginning of your pregnancy (but not sodium valproate) but you may need to increase the dose or add in other medication to control your epilepsy in your pregnancy. This is particularly important around the time you give birth when your sleep may be disrupted which can also increase the chance of having seizures.
Timing of birth
Normally the timing of birth is not affected by your epilepsy. Your medical team may recommend having an epidural for pain relief in your labour so that you can rest and reduce your risk of becoming excessively tired.
How may this impact my birth choices?
It is likely your team will recommend you give birth in the hospital and in a birth setting where doctors are readily available, such as the labour ward, in case you have a seizure during or immediately after your labour. It is recommended not to labour in water in case you have a seizure.
How may this affect care after the birth?
It is really important that you follow normal epilepsy advice such as taking showers instead of baths. Additionally, you will be advised not to change your baby’s nappy on a high surface but to use a change mat on the floor. There are lots of other helpful tips available from the links below.
This will have been made before pregnancy. All women with Type 1 diabetes should be offered preconception counselling to optimise their health.
What does this mean?
For me: Pregnancy can increase your risk of developing or worsening your pre-existing diabetic eye or kidney problems. In the first trimester you are at higher risk of having episodes of low blood sugar. In the second half of the pregnancy you are at higher risk of diabetic ketoacidosis and pre-eclampsia and preterm delivery. You will need to attend more hospital visits during pregnancy and you will be under the care of a specialist team.For my baby: There is a greater risk of having a miscarriage or stillbirth. There is an increased risk of congenital abnormalities (birth defects for your baby) when your blood glucose levels are high at the time of conception, and during the first trimester. In the second half of pregnancy high blood sugar levels can increase the size of your baby or there may be a growth restriction (slow growth). This can make it make the delivery of your baby more complex. Your baby is more likely to have low blood glucose after they are born and may have other health conditions requiring specialist support.
What will the medical team recommend?
You will be seen in a joint diabetes and pregnancy clinic. Your first scan should take place at 7-9 weeks and you will need extra scans throughout the pregnancy. You will be asked to make changes to your diet and maintain/increase your physical activity.
What tests will/may be considered? How often may they be needed?
You will be asked to measure your blood sugar levels more often. You will be given more support for blood glucose monitoring and offered a continuous glucose monitoring sensor and will be given a ketone meter. You will be reminded what your target blood glucose levels should be and you should aim to keep your blood glucose within that range at least 70% of the time. You will need regular eye check-ups during pregnancy. Your blood pressure and kidney blood tests will also be monitored very closely.
What symptoms and signs should I be looking out for?
Morning sickness in the first trimester may affect your blood sugar levels. You may need anti-sickness medication if you are vomiting, so let your specialist maternity team know. Anti-sickness medication is safe to use during pregnancy. You are more likely to be unaware of your low blood sugars. You should have a glucagon pen at home and your partner/family should know how to administer this in an emergency should you become unwell.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you feel unwell or unable to take your regular insulin you must attend the hospital immediately. If your baby is not moving you should attend the hospital immediately.
How are recommendations made regarding treatment options?
You should be taking 5mg folic acid daily at least 3 months before conception and up to 16 weeks of pregnancy. To reduce your risk of pre-eclampsia you should take 75mg-150mg of aspirin each night from 12 weeks until 36 weeks. Your insulin doses will change during pregnancy. For example you may notice a drop in your insulin requirements in early pregnancy (typically at 8-16 weeks) and an increase in insulin requirements in the second half of your pregnancy. Be sure to discuss all treatment with your specialist team at the hospital.
How are recommendations made regarding timing of birth
You will be advised to deliver around 38 weeks gestation. This may be earlier if there are concerns about you, your blood glucose levels, or your baby. By 36 weeks your team should be working with you to make a plan for the birth.
How may this impact my birth choices?
You may be offered an induction of labour if your team feels it is safer to do so. You will need blood glucose monitoring throughout labour.
How may this affect care after the birth?
You and your baby will need to be monitored very closely after birth. Your baby is at risk of low blood sugar levels after birth. If you are breastfeeding you may find that your glucose levels drop quickly while you are feeding, and afterwards. A birth plan prior to delivery should have been agreed to regulate your insulin requirement.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Look after your health between pregnancies.
What will this mean for future/my long-term health and how can I influence this?
Contraception and a follow up plan should be agreed before you are discharged from maternity care.
This will have been made before pregnancy. Ideally all women with type 2 diabetes should be offered preconception counselling to optimise their health.
What does this mean?
For me: Pregnancy can increase your risk of developing or worsening your pre-existing diabetic eye or kidney problems. You are at higher risk of diabetic ketoacidosis and pre-eclampsia. You will need to attend more hospital visits during pregnancy and you are more likely to be delivered early (around 38 weeks of pregnancy).For my baby: There is a greater risk of a miscarriage or stillbirth. There is an increased risk of congenital abnormalities if your blood glucose levels are consistently raised at the time of conception. In the second half of pregnancy the sugar level can increase the size of your baby or there may be growth restriction slow growth). This can make it make the birth of your baby more complex. Your baby is more likely to have low blood glucose levels (hypoglycaemia) after birth and may have other health conditions requiring specialist support.
What will the medical team recommend?
You will be seen more frequently in a joint diabetes and pregnancy clinic. Your first scan should take place at around 7-9 weeks and you will need extra scans throughout the pregnancy. You will be asked to make changes to your diet and maintain/or increase your physical activity.
What tests will/may be considered? How often may they be needed?
You will be asked to measure your blood sugar levels at least four times a day: once before breakfast (fasting) and one hour after each meal. You will be given more support for blood glucose monitoring and may be offered a continuous glucose monitoring sensor. You will need eye check-ups during pregnancy. Your blood pressure will also be checked regularly.
What symptoms and signs should I be looking out for?
Morning sickness in the first trimester may affect your blood sugar levels. You may need anti-sickness medication if you are vomiting, so let your team know. Anti-sickness medication is safe to use during pregnancy.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you feel unwell or are unable to take your regular insulin you must attend the hospital. If your baby is not moving you should attend the hospital immediately.
How are recommendations made regarding treatment options?
You should be taking 5mg folic acid daily at least 3 months before conception and up to 16 weeks of pregnancy. To reduce your risk of pre-eclampsia you should take 75mg-150mg of aspirin each night from 12 weeks until 36 weeks. Medications that are safe to use in pregnancy are metformin and insulin. You may need more insulin as you progress through your pregnancy.
How are recommendations made regarding timing of birth?
You will be advised to deliver around 38 weeks gestation. This may be earlier if there are concerns about you, your blood glucose levels or the size of your baby. By 36 weeks your team should be working with you to make a plan for the birth.
How may this impact my birth choices?
You may be offered an induction of labour if your team feel it is safer to do so. You will need blood glucose monitoring throughout labour.
How may this affect care after the birth?
You and your baby will need to be monitored very closely after birth. Your baby is at risk of low blood glucose levels after birth. If you are breastfeeding you may find that your glucose levels drop quickly while you are feeding, and afterwards. A birth plan prior to delivery should have been agreed to regulate your insulin requirement.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
Look after your health between pregnancies.
What will this mean for future/my long-term health and how can I influence this?
Contraception and a follow up plan should be agreed before you are discharged from maternity care.
You would have been screened for GDM if you have any of the following risk factors:
obesity
previous 4.5 kg baby
family history with diabetes
your ethnicity
previous gestational diabetes: or
you have persistent sugar in your urine. A blood test measuring your blood sugar (glucose) level after a sugary drink will confirm the diagnosis.
What does this mean?
For me: GDM increases your chance of developing pre-eclampsia during your pregnancy and having type 2 diabetes mellitus later in life.For my baby: There is a greater risk of having a miscarriage. The blood sugar level can increase the size of your baby. This could make it harder for you to deliver your baby and can increase the risk of your baby having shoulder dystocia. Your baby would be at a greater risk of developing obesity and or diabetes mellitus in their later life.
What will the medical team recommend?
You will be seen more frequently in a joint diabetes and pregnancy clinic. You will be asked to make changes to your diet and increase your physical activity. These lifestyle changes will help reduce your blood sugar level.
What tests will/may be considered? How often may they be needed?
You will be shown how to check your blood sugar levels and told what your target blood levels should be. You will be asked you to measure your blood sugar levels four times a day, once before breakfast (fasting) and one hour after each meal. You will need to do this daily until you deliver your baby.
What symptoms and signs should I be looking out for?
GDM does not usually have any symptoms. If your blood sugar level is high you may feel you want to urinate more, be thirstier or have vaginal thrush (itching and white vaginal thrush.
What are the ‘red flag’ symptoms/concerns, which means that they should be reported immediately?
If you feel unwell or your baby is moving less than normal.
How are recommendations made regarding treatment options?
Firstly you will be advised on diet changes and if this does not help you could be offered metformin or insulin. All these medications are safe for your baby.
How are recommendations made regarding timing of birth?
This may change depending upon the size of a baby and your blood sugar control.
How may this impact my birth choices?
We may advise you to deliver your baby before your due date.
How may this affect care after the birth?
You can stop checking your blood glucose levels after you have had your baby.
What will this mean for future pregnancies? How can I reduce my risk of this happening again?
GDM can increases your risk of developing gestational diabetes in a future pregnancy. It’s important to eat healthily and take regular physical activity during pregnancy, and to keep it up after pregnancy. This will reduce the risk in future pregnancies.
What will this mean for future/my long-term health and how can I influence this?
GDM can increases your risk of developing Type 2 diabetes in the future. It’s important to eat healthily and take regular physical activity during pregnancy, and to keep it up after pregnancy. This will reduce your future risk of developing Type 2 diabetes. You will need to see your GP every year to check you haven’t developed type 2 diabetes mellitus.
Where can I find out more information about this condition?
During pregnancy your midwife or doctor will be checking to ensure that your baby is growing well. This is done at defined stages in the pregnancy, either by measuring your bump with a tape measure or by routine ultrasound scans. If there is a concern about the growth of your bump you may be referred for a growth scan. Your baby’s progress is plotted on a chart by the person taking the measurement (midwife, doctor or sonographer).
If your baby is found to be growing smaller than expected you may require additional ultrasound scans and antenatal appointments to monitor your baby’s wellbeing.
