Gestational Diabetes: What Every Pregnant Woman Should Know

Gestational diabetes mellitus (GDM) is diabetes that develops during pregnancy in women who did not have diabetes before. It is one of the most common medical complications of pregnancy and is particularly prevalent in the UAE and the wider Middle East region.

How Common Is Gestational Diabetes?

The International Diabetes Federation reports that GDM affects approximately 15–16% of pregnancies globally. In the UAE and Middle East, this rate is higher due to genetic predisposition, higher obesity rates, and lifestyle factors. A 2019 study published in BMC Pregnancy and Childbirth reported GDM prevalence of approximately 22–24% in some UAE hospitals.

Risk Factors

You may be at higher risk if you:

• Have a BMI above 30
• Have had gestational diabetes in a previous pregnancy
• Have a family history of type 2 diabetes (parent or sibling)
• Have had a previous baby weighing 4.5 kg (10 lbs) or more
• Are over 35 years of age
• Have polycystic ovary syndrome (PCOS)
• Are of South Asian, Middle Eastern, African, or Caribbean ethnic background

Screening and Diagnosis

When Is Screening Done?

NICE guideline NG3 (Diabetes in pregnancy) recommends:

• Risk factor assessment at the booking visit (before 10 weeks)
• Oral glucose tolerance test (OGTT) at 24–28 weeks of gestation for women with risk factors
• If previous GDM: OGTT at 16–18 weeks and again at 24–28 weeks if the first test is normal

How Is the OGTT Done?

1. 1Fast overnight (at least 8 hours)
2. 2Blood sample taken for fasting glucose level
3. 3Drink a glucose solution (75 g glucose)
4. 4Blood sample taken again after 2 hours

Diagnostic Criteria (NICE NG3)

GDM is diagnosed if either:

• Fasting glucose is 5.6 mmol/L or above, or
• 2-hour glucose is 7.8 mmol/L or above

How Does Gestational Diabetes Affect Pregnancy?

If not well managed, GDM can lead to:

Risks for the Baby

• Macrosomia (large baby, over 4 kg), which may lead to birth complications
• Shoulder dystocia during delivery
• Neonatal hypoglycaemia (low blood sugar after birth)
• Jaundice in the newborn period
• Respiratory distress
• Increased long-term risk of obesity and type 2 diabetes

Risks for the Mother

• Higher chance of needing a caesarean section
• Pre-eclampsia (high blood pressure in pregnancy)
• Polyhydramnios (excessive amniotic fluid)
• Higher risk of developing type 2 diabetes later in life - NICE states that women with GDM have up to a 50% risk of developing type 2 diabetes within 5 years of giving birth

Management of Gestational Diabetes

Dietary Changes

• The foundation of GDM management
• Eat regular meals and snacks (3 meals + 2–3 snacks daily)
• Choose complex carbohydrates (wholemeal bread, brown rice, oats)
• Include protein with each meal (eggs, chicken, fish, legumes, dairy)
• Limit sugary foods and drinks
• Avoid skipping meals (causes blood sugar fluctuations)

Blood Sugar Monitoring

Self-monitoring of blood glucose is essential:

• Fasting: Below 5.3 mmol/L
• 1 hour after meals: Below 7.8 mmol/L
• 2 hours after meals: Below 6.4 mmol/L

Physical Activity

• Regular moderate exercise helps control blood sugar
• Walking after meals is particularly effective
• Swimming, prenatal yoga, and stationary cycling are safe options
• Aim for 30 minutes of activity on most days
• Discuss any new exercise routine with your obstetrician

Medication

If diet and exercise alone do not achieve target blood sugar levels:

• Metformin may be offered (NICE recommends this when lifestyle measures are insufficient)
• Insulin may be needed if targets are still not met
• All medications are prescribed and monitored by your medical team

After Delivery

• Blood sugar levels usually return to normal after delivery
• Your blood sugar will be checked after birth and before you leave the hospital
• 6-week postnatal OGTT: NICE recommends a fasting glucose test at 6–13 weeks after delivery to check if diabetes has resolved
• Annual HbA1c testing: Due to the increased lifetime risk of type 2 diabetes

Prevention for Future Pregnancies

• Maintain a healthy weight before your next pregnancy
• Stay physically active
• Choose a balanced diet
• Be screened early in future pregnancies

This article is for informational purposes only and does not replace professional medical advice. Always consult your doctor for personalised guidance.