Gestational diabetes and the family

Information for partners, family and friends on gestational diabetes

There is a greater awareness of diabetes these days, but when it comes to gestational diabetes, this can be an unknown territory for many. It can be very scary and sometimes confusing for partners, family members or friends to understand, especially if some already have other types of diabetes. So what does gestational diabetes mean for your loved one and what can you do to support them? Hopefully, this page will help you.

What is gestational diabetes?

Gestational diabetes is diabetes specifically in pregnancy. It can have the same characteristics as other types of diabetes, but it is diabetes that becomes present in pregnancy only.

Whereas the focus for other types of diabetes is the effects on the individual, with gestational diabetes the focus is on the effect diabetes has on the growing baby.

What causes gestational diabetes?

In short, the hormones from the placenta cause increased insulin resistance.

As a partner, family member or friend to a mother diagnosed with gestational diabetes it is important to know that the mother has done nothing wrong to cause the diagnosis. Some women are at higher risk of developing the condition and others have no risks whatsoever and still develop gestational diabetes.

ANY PREGNANT PERSON CAN BE DIAGNOSED WITH GESTATIONAL DIABETES.

anyone can be diagnosed with gestational diabetes

Diabetes is caused by too much glucose (sugar) in the blood. The amount of glucose in the blood is controlled by a hormone called ‘insulin’. During pregnancy, the body produces a number of hormones, such as oestrogen, progesterone and human placental lactogen (HPL). These hormones make the body insulin resistant, which means the cells respond less well to insulin and the level of glucose in the blood remains high.
To cope with the increased amount of glucose in the blood, the pregnant body needs to produce more insulin. However, some women either cannot produce enough insulin in pregnancy to transport the glucose into the cells, or their body cells are more resistant to insulin. This is known as ‘Gestational Diabetes Mellitus’ [GD or GDM]. Gestational diabetes can be defined as carbohydrate intolerance. For more information on gestational diabetes and diagnosis, please read more here.

insulin requirements during pregnancy
Fig 1. Marcinkevage, J.A., & Narayan, K.M. (2011). Gestational diabetes mellitus: taking it to heart. Primary care diabetes, 5 2, 81-8

What does gestational diabetes mean for the baby?

Not just big babies

Gestational diabetes means that blood sugar levels within the mother remain high and this excess sugar is passed onto the growing baby. The baby has to increase its own insulin production in order to process this sugar.  As insulin is a growth hormone, the result if not treated, can mean that the baby grows larger than it would normally, hence many presume that “gestational diabetes just means a bigger baby“. Unfortunately, it is not as simple as your loved one just having a bigger, bouncing baby that they’ll have to birth.

Gestational diabetes is a serious condition that can cause many complications, not only during the birth due to size but both during pregnancy and for the baby following birth.

Undiagnosed or uncontrolled gestational diabetes can lead to stillbirth or other serious complications. But if gestational diabetes is diagnosed and controlled well then the risk of complications is reduced significantly.

The majority of ladies who gain good control over their blood sugar levels with dietary changes and if necessary with the help of medication and/or insulin, go on to deliver average-sized babies with little or no complications.

For further details on some of the complications caused by gestational diabetes, please read more here.

Impact on mental health

Diagnosis of Gestational diabetes can be extremely scary, daunting and confusing. Due to hype in the media and lack of knowledge about gestational diabetes, many women blame themselves for causing the condition and will often feel guilty and be extremely upset and tearful.

What may have been the perfect pregnancy could feel completely shattered, or additional complications to an already difficult pregnancy may feel like the last straw for them.

Many mothers are completely unaware of gestational diabetes and once diagnosed may stop eating in fear of causing high blood sugar levels and consequently harming their baby.

Some women are devastated that this could mean a pregnancy which is filled with additional hospital appointments, medication, insulin injections, and intervention and feel like they will not be able to have the pregnancy and birth they hoped for. Many fear that they will now be diabetic for the rest of their life.

pregnant mother sitting on bed upset

GESTATIONAL diabetes, not Type 1, Type 2, or MODY

If family members have diabetes, there is an increased risk of developing gestational diabetes and so the likelihood is that many mothers who are diagnosed will have family members that have other forms of diabetes.

This can actually confuse matters because advice and managing the different types of diabetes can be very different.

With gestational diabetes, there is a very short amount of time to get to grips with the diagnosis and try to control blood sugar levels. Therefore what you know about your own diabetes many be completely different or even irrelevant to someone with GD.

Gestational diabetes requires very close monitoring of blood sugar levels, multiple times daily and targets are generally much lower than those advised for other types of diabetes. To complicate matters further, different targets and test times are used all over the UK and ROI. There are national guidelines however some NHS Trusts use their own test times and targets.

National guidelines for testing

NICE Guidelines for testing

1.3.5 Advise pregnant women with any form of diabetes to maintain their capillary plasma glucose below the following target levels, if these are achievable without causing problematic hypoglycaemia:
fasting: 5.3 mmol/litre and
1 hour after meals: 7.8 mmol/litre or
2 hours after meals: 6.4 mmol/litre. [2015]

1.3.6 Advise pregnant women with diabetes who are on insulin or glibenclamide to maintain their capillary plasma glucose level above 4 mmol/litre. [2015] NICE Guidelines NG3 Diabetes in Pregnancy

Dietary advice given to gestational diabetes patients at the hospital is often based on following a general low-fat, healthy eating diet or can be very outdated and this is where mothers struggle as many of the typically recommended foods such as breakfast cereals, fruit such as grapes as ‘healthy snacks’ and other high-carbohydrate foods such as crumpets, low-fat yoghurts, malt loaf etc often causes high blood sugar levels.

The dietary advice someone with GD is given, may not be the best

This is why I have researched and devised the 8 golden rules of eating which we know to work best for women with GD.

list of the GD UK 8 Golden Rules for a gestational diabetes diet

As gestational diabetes is driven by hormones, these hormones fluctuate dramatically which creates surges in insulin resistance making gestational diabetes very unpredictable. Therefore where a person with Type 1 or insulin-dependant diabetes may be able to titrate insulin doses based on carbohydrate amounts, this is much harder with gestational diabetes and during pregnancy.

Gestational diabetes is a progressive condition which worsens as the pregnancy goes on and so the need for increased control and management is necessary for most mothers, especially from 32 – 36 weeks when insulin resistance is at its worst.

increasing insulin resistance in pregnancy

Once the baby and placenta have been delivered, unlike other types of diabetes, gestational diabetes is gone. Women diagnosed with gestational diabetes are at a higher risk of developing Type 2 diabetes later in life and should be tested following birth and then annually. For further information on diabetes testing following birth, please read more here.

“One bite won’t hurt you”

One of the main reasons for writing this page is for all the mothers that come into my support group upset and frustrated that their loved ones, partners, family and friends can’t understand that they are desperately abstaining from certain foods.

Gestational diabetes comes at a time when many ladies are dealing with cravings and pregnancy emotions and a huge piece of chocolate cake, a tub of ice cream, a massive bar of chocolate, a family-sized share bag of sweets or a bottle of wine would easily be the answer to all their dreams! But, obviously, they can’t do that.

Many may be struggling with keeping their blood sugar levels under control when eating something as simple as a piece of bread or an apple and so the last thing they will want to be offered is something they know for sure is going to cause high blood sugars which will straight away be passed onto their growing baby.

Even those diagnosed with GD but with well-controlled blood sugar levels often give birth to babies which suffer milder complications. Most commonly, babies with low blood sugar levels (hypoglycaemia) and jaundice. By the mother being strict and controlled with her diet and in many cases alongside medication or insulin, the baby maintains their own insulin production which means they are not as likely to suffer these complications and so this is why many mothers would prefer to abstain completely, rather than having the odd treat.

gestational diabetes and family

One bite may not ‘hurt them’, but they know it can be a slippery slide to something they are avoiding which can ultimately hurt their baby and so this is why many would prefer to not have just a small piece or one bite of something.

Ongoing support from partners, family and friends

Some mothers may deal with diagnosis very well, but with gestational diabetes being a progressive condition, it gets tougher the further into the pregnancy they go, typically between 32 – 36 weeks.

Many women feel they have got on top of the condition and have just started understanding which foods are considered safe when all of a sudden they start getting high blood sugar levels.

32-36 weeks the hardest time

They may be completely fed up with eating the same things repeatedly every day. They may feel, emotional over having to start Metformin when they do not want to take any medication during the pregnancy, or inject insulin when they have a fear of needles.

They may be advised to have an induction, or could be advised against having a water birth or home birth which they had their heart set on and this could mean contemplating and trying to make some very important decisions on what’s best to do, having to stand their ground and put a case forward in order to get the birth they want.

At these times they will need family and friends to talk to and may need a shoulder to lean on.

A growth scan or clinic appointment may be the tipping point, or even just burning the one piece of bread they had left that they CAN eat, or someone celebrating a Birthday at work with cakes, or being surprised with a baby shower where there’s no food suitable for them to eat and lots of tempting cakes and sweet treats instead all may trigger an emotional outburst, upset or anxiety.

All the things mentioned above are available to read about in detail on our website and being part of our Facebook support group with others dealing with the same feelings will help, but ultimately support from loved ones can make a huge difference.

How partners, family and friends can support loved ones diagnosed with gestational diabetes

  1. Learn about the condition and the complications it can cause – our website is a great tool to use
  2. Understand that they have done nothing wrong to cause diagnosis
  3. Be there for them, knowing that they may be upset and scared and the diagnosis can be detrimental to their mental health
  4. Learn about the differences between gestational diabetes and other types of diabetes
  5. Take a look at our dietary advice to understand the foods and drinks they may struggle with
  6. Don’t offer them things as treats unless they have expressed a wish and chosen to eat them
  7. Avoid indulging in foods which they are abstaining from, or eating these types of foods or drinks in front of them if it upsets them
  8. Avoid eating the last of their specially selected GD friendly treats that they CAN eat!
  9. If they are treated with insulin, learn about hypos and how to treat them with gestational diabetes
  10. If you like cooking and baking try some low-carb, low sugar alternative recipes (you could even sign up to our recipe subscription for them to give them help with food ideas, recipes and meal plans. For an example one-day meal plan, read more here). If planning a baby shower, try to remember that it should be enjoyable and not torture. We have a post dedicated to GD Baby showers here.
Do some GD-friendly baking!

Watch the Gestational Diabetes – One Prick At A Time Short Film

GESTATIONAL DIABETES : ONE PRICK AT A TIME was commissioned by Kings College London research fellow and NHS psychiatrist Dr Claire Wilson from a fellowship funded by the MRC, with support from fellow King’s College London researcher Judith Parsons and Jo Paterson of Gestational Diabetes UK. The project is also supported by King’s Culture and the Mental Elf.