Time to think about preventing Type 2 diabetes after gestational diabetes?
You may have risk factors which contributed to you being diagnosed with gestational diabetes which may also make you higher risk for developing Type 2 diabetes. But even if you didn't have ANY risk factors for gestational diabetes, you still need to think about preventing Type 2 diabetes after gestational diabetes, as having gestational diabetes itself is a risk factor for Type 2.
Having gestational diabetes gives you a seven-fold increased risk of developing type 2 diabetes. It also gives your baby a six-fold increased risk of developing type 2 diabetes and obesity later in life, meaning it is best to not only think of your own diet and lifestyle choices, but also your family's.
Risk of developing Type 2 diabetes after gestational diabetes for the mother
Gestational diabetes increases your risk of developing type 2 diabetes after the pregnancy. Statistics from Diabetes UK state that there is a seven-fold increased risk in women with gestational diabetes developing type 2 diabetes in later life.
NICE state that up to 50% of women diagnosed with gestational diabetes develop type 2 diabetes within 5 years of the birth.
and a meta-analysis published in March 2014 state:
In a systematic review conducted in 2009, body fat measures had the most consistent associations with diabetes risk compared with other types of factors including age, parity and family history of diabetes. Specifically, pre-pregnancy BMI was associated with significantly increased risk of future diabetes after a gestational diabetes delivery; for every 1 kg increase in pre-pregnancy weight, there was a 40% increase in odds of developing Type 2 diabetes (odds ratio 1.40, 95% CI 1.20–1.60). Intra-partum and post-partum weight measures were also associated with increased diabetes risk
A 2002 publication from Diabetes Care comparing 28 studies found that elevated fasting levels during pregnancy was the most common risk factor associated with future risk of type 2 diabetes:
Cumulative incidence of type 2 diabetes increased markedly in the first 5 years after delivery and appeared to plateau after 10 years. An elevated fasting glucose level during pregnancy was the risk factor most commonly associated with future risk of type 2 diabetes.
Risk of developing Type 2 diabetes after gestational diabetes for the baby/child
According to stats and facts from Diabetes UK:
Children born to mothers with diabetes during pregnancy tend to have a greater BMI, raised fasting glucose levels and an increased risk of developing Type 2 diabetes later in life.
The latest research suggests they have a sixfold increased risk of developing Type 2
Preventing type 2 diabetes after gestational diabetes in the mother
There are some data suggesting that changes in diet and exercise, with or without metformin, can prevent type 2 diabetes developing in non‑pregnant middle‑aged people with glucose intolerance, but there are no studies specifically in women with a past history of gestational diabetes
NICE have a whole guideline dedicated to prevention of Type 2 diabetes in people at high risk (which would include those that have had gestational diabetes) which involves further information on lifestyle choices such as diet and exercise: NICE guidelines Type 2 diabetes: prevention in people at high risk - PH38 - Published:
Breastfeeding for preventing Type 2 diabetes after gestational diabetes
There has been lots of research which shows that breastfeeding can reduce the risk of developing Type 2 diabetes in both the mother and the baby.
We have a detailed post on breastfeeding after gestational diabetes which specifically shows the evidence behind preventing Type 2 diabetes after gestational diabetes pregnancy.
Dietary changes for preventing Type 2 diabetes after gestational diabetes
Many ladies are shocked to see the amount of sugar or carbs (which turn into sugar) is present or hiding in the food and drinks they were consuming previously to being diagnosed with gestational diabetes, many of which are deemed as 'healthy' dietary choices.
For many ladies it is the turning point of making better dietary choices for the future, not only for themselves but for their partners and children too.
But with so many different dietary choices to chose from, which would be the best for reducing the risk of developing Type 2 diabetes after gestational diabetes?
The question you may want to ask yourself is what is your BMI? Do you have weight to lose? If the answer is yes, then a diet which would help you reduce your BMI to a healthier level would be beneficial. Some ladies prefer to return to or join weight loss programs such as Slimming World or Weight Watchers. Others, after finding the gestational diabetes diet causes them weight loss prefer to return to a low carb, high fat diet. The dietary advice we highly recommend is that of the Public Health Collaboration.
The Public Heath Collaboration dietary advice - Real Food Rocks!
Paving the way forward for the future
One thing you may have noticed during your gestational diabetes journey is that the dietary advice you were given may have made controlling your blood sugar levels harder or more difficult than the dietary advice we advocate.
Unsurprisingly, the dietary advice for those with Type 2 diabetes and pre-diabetes is the exact same advice in many hospitals and after many years of rapidly increasing cases of obesity and Type 2 diabetes, a group of medical professionals called the Public Health Collaboration have come together and have started challenging the standard NHS advice such as the 'Eatwell guide'.
Simply, it's not working:
In the UK 25% of adults are obese, the highest prevalence in Europe, and type 2 diabetes has risen by 65% in the past 10 years with no sign of slowing down, both cost the NHS £16 billion a year
The Public Heath Collaboration are advocating a low carb, high fat (LCHF) diet very similar to the gestational diabetes diet we recommend based on research. Their aim is to change the UK dietary advice, improve public health and educate GPs.
Not just a diet for weight loss - the Real Food Lifestyle
Not only have the Public Health Collaboration launched a guideline for weight loss, but they have also launched a guideline for general healthy eating and so if you do not have high BMI but would like to reduce the risk of developing Type 2 diabetes after gestational diabetes, the PHC healthy eating guideline is extremely beneficial advice.
The PHC Real Food Lifestyle:
1. Eat real food, until you're satisfied. These are foods that are naturally nutrient dense and are minimally altered from their natural state, which will nourish you and satisfy hunger.
2. Avoid fake foods, as much as you can. These are foods that have been highly processed from their natural state with free sugars, highly-processed oils and fortified nutrients, which do not nourish you and will not satisfy hunger.
3. Be active everyday, with an activity you enjoy. Whether it be a brisk walk up the stairs or a vigorous workout in an exercise class, it'll help improve cardiovascular health, mood and sleep.
To view the whole guideline, please see PHCUK Healthy Eating Guidelines and Weight Loss Advice for the United Kingdom or visit their website www.phcuk.org for further information.
The PHC is 100% funded by donations and so if you would like to make a donation, you can do so here.
*Please note, Gestational Diabetes UK is not affiliated with the Public Health Collaboration, we simply advocate their Real Food Lifestyle advice based on what we have seen and observed as mothers with gestational diabetes who are at high risk of developing type 2 diabetes, or who have been diagnosed with type 2 diabetes and follow the PHC dietary advice and have seen improved HbA1c levels and/or weight loss as a result
Exercise for preventing Type 2 diabetes following gestational diabetes
We have a whole post written by Mel C AKA the Mummy Trainer which includes a post natal workout for mothers who have had their babies.
Remember it's not just about you, it's about your child's future too
Preventing Type 2 diabetes after gestational diabetes is just as important for your child too.
Knowledge is power! Use what you've learnt during your pregnancy to make better choices for your family too.
So many ladies are shocked to see that a small 47g pot of fruit fromage frais (such as a Petit Filous) has around 1 ½ tsp of sugar in each one, that a Frijj milkshake has upto 13 tsp of sugar in a bottle and jar sauces (such as Dolmio) can have around 10 tsp of sugar (and that's just the sauce without any pasta or garlic bread)! I could list loads of examples here, but many of you will know where that sugar is hiding now, so use that knowledge when planning family meals.
- Stick to real food - remember #RealFoodRocks!
- Don't fear fat
- Cook from scratch so you know what's in it
- Food treats do not have to be bad for you, there's loads of good choices that your kids will think are scrummy (even for the fussiest eaters) that are actually packed with goodness and can still be a 'treat food'! GD brownies are a winner in most households, as are a big bowl of strawberries and cream!
- And food isn't the only treat or reward! Cuddles, kisses and fun with the family can't be replaced by a bag of Haribo!
Annual HbA1c blood tests
You should be tested for Type 2 diabetes annually following gestational diabetes with a HbA1c blood test. If you notice any symptoms of diabetes in between annual tests then you should consult your GP for a test sooner. More advice of diabetes testing following gestational diabetes can be found here.
More research and information
In a meta-analysis of 20 reports , women with gestational diabetes had a sevenfold increased risk of diabetes compared with women without gestational diabetes (relative risk 7.43, 95% CI 4.79–11.51).
While weight gain between pregnancies and at the subsequent pregnancy were inconsistently associated with gestational diabetes risk in older reports , more recent reports suggest that maternal weight gain in between pregnancies might play a larger role in gestational diabetes recurrence, perhaps because of the steady increase in maternal pre-conception BMI over the past decade . In one recent examination of 22 351 women, women had a significant increase in their odds of gestational diabetes in their subsequent pregnancy with each unit of BMI gained between pregnancies . Specifically, women who gained 1–1.9 kg/m2 had a 1.7 increased odds of future gestational diabetes; women who gained 2.0–2.9 kg/m2 had a 2.5 increased odds and women who gained over 3 kg/m2 had a 3.4 increased odds . While less than 10% of women lost weight between pregnancies, women who were overweight or obese at their index pregnancy, but who then lost weight (approximately 2.0 kg/m2) significantly lowered their risk of future gestational diabetes by almost 80% (odds ratio 0.26, 95% CI 0.14–0.47). Of note, women who were not overweight at their index gestational diabetes pregnancy, but lost weight after their index pregnancy, did not significantly reduce their odds of future gestational diabetes. This suggests that attributable risk for gestational diabetes attributable to weight was low in these women, and that weight loss may not be an ideal target for intervention in this su bpopulation .
for every 1 kg increase in pre-pregnancy weight, there was a 40% increase in odds of developing Type 2 diabetes