I was recently reading an article in the Medical Journal of Australia by Shelley Wilkinson et al about the management of diabetes in pregnancy (gestation diabetes) or more specifically it’s management after the baby’s delivery (Who’s responsible for the care of women during and after a pregnancy affected by gestational diabetes?, Shelley A Wilkinson et al, Medical Journal of Australia, 2014).
This was an important paper and it made some great points.
A key message is that, as a nation, we need to improve the quality of care for women who have experienced gestational diabetes once they return to the community.
The following dot points summarise the most important messages I took from the paper.
- Gestational diabetes is common and occurs in approximately 10%–13% of all pregnancies
- Gestational diabetes carries increased risks of obesity and abnormal glucose metabolism for the child, and these risks continue into a child’s later life
- The general practitioner is the best source of advice about the ongoing management of diabetes
- Because of the realities of imperfect communication in the healthcare system it is important that the patient inform the general practitioner that she experienced diabetes during pregnancy
- If you have experienced gestational diabetes it is important to have an oral glucose tolerance test (OGTT) between six and 12 weeks after delivery
- If planning future pregnancies, an oral glucose tolerance test should be repeated annually. This recommendation will be modified based upon the patient’s specific risk factors and desire for future pregnancies.
- If there has been a background of gestational diabetes, lifestyle choices are important:
- any increase in physical activity will be helpful
- maintenance of an appropriate body weight through a combination of healthy food choices and exercise is important
- possible review by a dietician. Diet is fundamental to both the control of any current diabetes and decreasing long-term risks
- the benefits of weight loss and moderate exercise increase with increased risk of diabetes. Thus the more likely a woman is to experience diabetes in a future pregnancy or later in life, the greater the benefit she obtains from appropriate lifestyle choices
- When planning a future pregnancy the past history of gestational diabetes should be discussed with your healthcare team.
So as a simple summary: if you have experienced gestational diabetes, tell your GP and ask the question as to how it will be monitored.
Dr Brian Symon
The Babysleep Doctor