A study by researchers at the University of Edinburgh has recently revealed that 1 in 8 mothers in England are now diagnosed with diabetes whilst pregnant, amounting to an increase of 60% over the past 5 years. The biggest rises can be seen amongst women of colour (with cases in Asian women rising by 23% in the past 5 years), as well as those living in poverty (rising by 14% in 5 years).

What is gestational diabetes?

Gestational diabetes occurs when a mother develops high blood sugar levels during their pregnancy. It happens because their body cannot produce enough insulin (the hormone that controls blood sugar levels) to meet their body’s additional requirements during pregnancy. The condition usually then disappears after the baby is delivered. It can occur at any stage of pregnancy, but most commonly arises in either the second or third trimester.

This type of diabetes poses risks to both a mother and her baby’s health both during pregnancy, and after birth too. This risk can be reduced if gestational diabetes is identified early and is well-managed.

Gestational diabetes does not usually cause any symptoms, meaning that cases only tend to be identified when blood sugar levels are tested during screening for gestational diabetes.

It is possible for any woman to develop gestational diabetes during pregnancy; however, women are at increased risk of developing the condition if they:

• Are over 40
• Have a BMI over 30
• Have previously delivered a baby weighing over 4.5kg
• Have been diagnosed with gestational diabetes in a previous pregnancy
• Have a parent or sibling with diabetes
• Are of South Asian, Black, African-Caribbean or Middle Eastern origin
• Have had a gastric bypass or other weight-loss surgery

If any of the above risk factors apply, it is important that they are recognised and acted upon by the antenatal team and screening for gestational diabetes should be offered during her pregnancy.

Screening for gestational diabetes

During a woman’s booking appointment (their first antenatal appointment), which usually takes place at 8-12 weeks of her pregnancy, the midwife or doctor should ask some questions to try to identify whether they are at increased risk of developing gestational diabetes. If one or more of the above-listed risk factors are identified, a screening test should be offered.

This test involves an oral glucose tolerance test being performed, normally when a mother is 24–28 weeks’ pregnant. The test involves the mother having a blood test after fasting for 8–10 hours beforehand, then being given a glucose drink. Around 2 hours after drinking the glucose drink, a further blood test is performed, to allow the doctors to check how the mother’s body is processing the glucose.

If the mother has been diagnosed with gestational diabetes in a previous pregnancy, this test should be offered earlier on in her pregnancy, within a few weeks of her initial booking appointment. A second test is then carried out between 24–28 weeks, if the first test result comes back as normal.

Treatment for gestational diabetes

If a diagnosis of gestational diabetes is made, the treating doctors and midwives should help the mother to monitor and control her blood sugar levels. The mother should be given a blood sugar testing kit and be supported to use this. This testing process involves using a finger-pricking device to put a drop of blood on a strip for testing. The doctors and midwives should let the mother know how to test her blood sugar levels properly, when to do so, what sugar levels are recommended and this information should be passed on to her treating team, to make sure that the right advice and treatment can then be provided.

Appropriate management is not simply achieving a diagnosis and effective follow-up is required. The mother should also be referred to a dietician, to provide advice about her diet and what foods to avoid and help her to plan healthy meals. She should also receive guidance about safe ways to exercise during her pregnancy, as exercise can also help to reduce blood glucose levels.

If these lifestyle changes do not help to lower her blood sugar levels enough after 1-2 weeks, the mother may also need to be prescribed either tablets or insulin injections to help too.

Monitoring gestational diabetes

The mother should be closely monitored both during the remainder of her pregnancy, and during the baby’s birth, to look out for any complications arising as a result of her diagnosis. Extra antenatal appointments should be offered, to allow the treating team to check on the baby’s growth and the amount of amniotic fluid surrounding the baby in the womb.

The diagnosis can also impact the management of the birth. If a gestational diabetes diagnosis has been given, the doctors will likely recommend delivery before 41 weeks, or even earlier if there are any concerns about the baby’s health. They may recommend either induction of labour or a caesarean section, if labour hasn’t commenced naturally by this point.

After birth, the mother should be encouraged to feed their baby within 30 minutes of delivery and then every 2–3 hours after, until the baby’s blood sugar levels stabilise. The baby’s blood sugar levels will need to be regularly tested and closely monitored during this time.

Mothers who have been diagnosed with gestational diabetes during their pregnancy should be offered a blood test between 6–13 weeks post-delivery, as a small number will continue to have raised blood sugar levels. Even if the result is normal, they will need to be annually screened for diabetes, because gestational diabetes increases the risk of developing type 2 diabetes following pregnancy.

Impact of gestational diabetes on pregnancy

Most women who are diagnosed with gestational diabetes during their pregnancy go on to have a normal healthy pregnancy and delivery of their baby. However, gestational diabetes, especially if not well managed, increases the risks of:

• A larger baby, which can cause issues during delivery and increases the risk of requiring either an induction or caesarean section to facilitate delivery;
• Too much amniotic fluid in the womb, which in turn can cause either premature labour or problems during delivery;
• Premature birth;
• Pre-eclampsia;
• Jaundice;
• Stillbirth

As a clinical negligence solicitor, I often speak with families who are trying to understand the complications of pregnancy, labour or the early neonatal period. Gestational diabetes is one area where failures in terms of timely screening and careful monitoring can impact the outcome. A failure of the doctors and midwives to test for and diagnose gestational diabetes, or to help a mother treat gestational diabetes once diagnosed could amount to medical negligence, if it results in implications on either the mother or baby’s health.

Where an avoidable injury occurs, families may be entitled to compensation and may want to seek legal advice regarding a potential medical negligence claim. Experiencing complications during pregnancy, labour or birth can be overwhelming, particularly where there are concerns that opportunities to prevent harm were missed.

At JMW Solicitors, we often investigate such cases. We will obtain and review the relevant medical records, advise on whether there may be grounds for a claim, and arrange independent expert evidence, where appropriate in order to advise in respect of a potential clinical negligence claim.