Australia’s peak diabetes organisations have welcomed new recommendations from the Australasian Diabetes in Pregnancy Society (ADIPS) that update the way gestational diabetes mellitus (GDM) is diagnosed, saying the changes will help better target care to the women who need it most.

The updated guidelines, published today in the Medical Journal of Australia, recommend higher blood glucose thresholds for diagnosing GDM and introduce more tailored screening for women with known risk factors early in pregnancy. said these evidence-based changes aim to ensure women and their babies receive appropriate care without over-medicalising pregnancies where the risk of complications is low.

黑料网, the and the joins with ADIPS in supporting the changes, as have other peak health bodies, reflecting broad consensus across diabetes management.聽

For the first time, Australia’s leading experts in GDM including general practitioners, obstetricians, midwives, diabetes clinicians and pathologists, have united behind a national approach to improve the consistency and clarity of GDM diagnosis. This collaboration marks a significant milestone in maternal health and diabetes care.

More than 280,000 women give birth in Australia each year, and GDM affects nearly one in five pregnancies. Appropriate diagnosis and treatment are critical in reducing the risk of complications during pregnancy and birth, and in helping women avoid long-term health issues such as type 2 diabetes.

It’s critically important that every woman who develops GDM is identified and supported with the care she needs. These updated guidelines will facilitate that goal by focusing healthcare resources where they can make the biggest difference on women and babies most at risk.

The recommendations follow a decade of evolving research and reflect the lived experience of women who have had GDM, alongside the clinical insights of the country鈥檚 leading diabetes and maternity care professionals.

Implementation of the new recommendations will be rolled out across hospitals and primary care settings over the coming months.

黑料网 has joined forces with the peak society for diabetes in pregnancy to forge a stronger alliance to address the diabetes epidemic.

The Australasian Diabetes in Pregnancy Society (ADIPS) has become an Associate Member of 黑料网 in a move that will strengthen support and advocacy for pregnant women with diabetes.

ADIPS is committed to advancing clinical and scientific knowledge of diabetes in pregnancy and its effect on the child, mother, and wider family. Associate membership of 黑料网 will significantly contribute to that work.

黑料网 Group CEO Justine Cain said the partnership will deliver better outcomes for women with diabetes and further demonstrates 黑料网鈥檚 commitment to provide leadership and support for the diabetes community. 

鈥満诹贤� is steadfast in our commitment to leading and implementing strategies that affect change which improve the lives of people living with, and at risk of, diabetes,鈥� Ms Cain said.

鈥淕estational diabetes (GDM) is the fastest growing type of diabetes in Australia, making pregnant women a significant focus of prevention and care work.

鈥淢others have a higher risk of developing type 2 diabetes later in life after experiencing GDM in their pregnancy, and the risk is also higher for the children of those pregnancies.

鈥淏y unifying our efforts with ADIPS, we are creating a stronger voice for pregnant women with diabetes and increasing our ability to support them,鈥� Ms Cain said.

The number of women diagnosed with GDM annually has more than doubled over the past decade. In the 12 months to June 2023, more than 44,700 women were diagnosed with GDM.

ADIPS President Professor David Simmons said a stronger partnership with 黑料网 would further strengthen Australian and New Zealand international leadership in clinical practice, research and advocacy for women with diabetes in pregnancy, their families and care providers.

鈥淎DIPS is passionate about helping ensure that pregnancies complicated by diabetes are safe and happy.  We know how much work this can be for those with diabetes and their partners and are always striving to find ways to improve the experience while reducing the complications,鈥� Professor Simmons said.

鈥淎DIPS is delighted to work closely with 黑料网, as the leading consumer diabetes organisation in Australia, allowing us to collaborate with our expertise in diabetes in pregnancy, to the wider mission of supporting those with diabetes throughout the life course.鈥�

A first-of-its-kind international study led by Western Sydney University has shown that treatment of gestational diabetes from early pregnancy adds additional protection for babies and mothers from pregnancy complications.

Published in the prestigious New England Journal of Medicine, the new research explored whether treatment of gestational diabetes before 20 weeks鈥� gestation among those already at high risk improves maternal and infant health, finding a reduction in complications.

Through a randomised controlled trial performed at 17 hospitals in Australia, Austria, Sweden and India, the study screened over 43,000 women to recruit 802 women with a diabetes risk factor before 20 weeks鈥� gestation, who had gestational diabetes by the World Health Organization definition.

Lead author Distinguished Professor David Simmons from the University鈥檚 School of Medicine and Translational Health Research Institute said the study provides new evidence for those deemed at higher risk for early testing and treatment of gestational diabetes beyond the current recommended approach of intervening at 24-28 weeks.

鈥淭esting for gestational diabetes is offered routinely later in pregnancy and those at higher risk are also tested early on to exclude undiagnosed type 2 diabetes. If these early glucose values are increased, but below those diagnostic of type 2 diabetes, we feel we should treat but data has been lacking to demonstrate the effects of such treatment on the mother or baby; we have now filled this major knowledge gap likely affecting millions of pregnancies every year,鈥� said Distinguished Professor Simmons.

The study assessed pregnancy outcomes with the initiation of treatment for gestational diabetes before 20 weeks鈥�, compared with no early treatment and subsequent initiation of treatment depending on results of repeat oral glucose tolerance testing (OGTT) at 24-28 weeks鈥� gestation, with significant and unexpected findings relating to respiratory distress in babies.

The First Nations Health Unit delivers programs that are specifically focused on supporting Aboriginal and Torres Strait Islander people and those who are part of the Indigenous Health Workforce. If you鈥檙e reading this article, it is highly likely that you are a member of this Indigenous Health Workforce. Our full suite of offerings is on our website at the link at the end of this article, but right now we鈥檇 like to provide a focus on one program that you and your work colleagues may be interested in. This is the Understanding Diabetes for Aboriginal and Torres Strait Islander Health Workers and Practitioners program.

As the name implies, the program is focused on Health Workers and Practitioners, but all who work with Aboriginal and Torres Strait Islander clients and community are welcome to participate. The program provides foundational information and uses the Feltman and Feltmum education tool which is made by the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and Diabetes Victoria.

The program covers the usual topics you might expect in a session such as this and these include:

• what is diabetes;
• the difference between type 1, type 2 and gestational diabetes;
• symptoms;
• complications;
• preventing complications and diabetes management strategies.

In this program though, the topic of diabetes is presented from an Indigenous point of view. The program starts off by examining health before colonisation, then examines the health impacts that arose out of colonisation and concludes with examining the importance of social and emotional health and wellbeing, not merely examining diabetes from only a biomedical point of view.

As we have learnt to pivot and adapt to COVID restrictions over the past two years, we have become quite adept at our skills in online delivery. While our preference is always to deliver programs such as this face-to-face, we understand this is not always possible. We also understand that given the schedules and workloads of the Indigenous Health Workforce, it is not always possible to schedule every possible professional development opportunity into your already busy schedules.

Thus, we have developed this program so that it can be delivered face-to-face or online in a one-to-two-hour period (depending on the amount of conversation generated). While we have a rolling monthly schedule of online deliveries already incorporated into our calendar, the online nature of the program means that we can respond to you and your team at your convenience. Whether its two of you or twenty of you, we can work with you to deliver the program. If that sounds like something that would benefit you and your colleagues, please do not hesitate to contact us via email at firstnationshealth@diabetesqld.org.au.

https://www.diabetesqld.org.au/about-diabetes/first-nations-health-unit/training-for-health-workers/

Gestational diabetes mellitus (GDM) is a form of diabetes that occurs during pregnancy. It affects around 15% of pregnancies in Australia. Due to the significant number of women diagnosed and the possible health impact it can have for both mum and baby, GDM is routinely screened between 24-28 weeks during the pregnancy with an Oral Glucose Tolerance Test (OGTT). This may be completed earlier if there are known

During pregnancy, hormones produced by the placenta can reduce the action of insulin.

Insulin is a hormone

Insulin is the hormone needed to move glucose from the bloodstream into the cells in the body to be used for energy after eating food containing carbohydrates. With the action of insulin not working as well, the pancreas has to work harder and may not be able to produce enough insulin. This in turn leads to higher blood glucose levels.

Once diagnosed with GDM, a mother will need to work with her treating team to ensure blood glucose levels stay within a target range. Sometimes this is managed through lifestyle adjustments such as and exercise; however, some women may need some additional help through medication or insulin.

Glucose crosses to the baby

The reason higher blood glucose levels need to be avoided is that the extra glucose in the body can cross via the placenta to the baby and make them grow too big. This can lead to problems before, during and immediately after labour.

Once the baby is delivered the blood glucose levels of the mother usually returns to a normal range, which means they no longer have diabetes. For some woman, however, they may continue to have elevated glucose levels, in which case they now have either or

60% develop type 2 diabetes or pre-diabetes

Importantly, it is now understood that about 60% of woman who had GDM during pregnancy will go on to develop pre-diabetes or type 2 diabetes within 10-20 years. There is also a much higher risk of GDM in future pregnancies.

So after pregnancy, what should a Mum who had GDM know and be aware of?

In the immediate days and weeks after giving birth, life is most likely chaotic as mum and family adjust to their new life with a newborn. Although this can be a stressful period, it is important to ensure the mother remains connected with her health care team and follows some general advice and guidance.

From a food perspective it is important for a new mother to nourish her body with

There is strong evidence of the benefits breastfeeding can have on reducing future type 2 diabetes for both mother and baby. If diagnosed with either pre-diabetes or type 2 diabetes after birth, breastfeeding is also highly effective for helping the mother manage her blood glucose levels.

Here are some general steps for a GDM Mum to follow once her baby is delivered.

1. Ensure regular diabetes checks after birth 鈥� Between 6-12 weeks after delivery, an OGTT is recommended. It is believed 1 in every 5 women post pregnancy will still have higher blood glucose levels. Even if type 2 diabetes is not picked up during the screening it is recommended to repeat this test every 1-3 years depending on the level of risk.
2. Making healthy food choices 鈥� There is no specific diet when preventing or living well with type 2 diabetes. Choose a diet rich in vegetables, wholegrains, and legumes with moderate amounts of fruit, dairy, lean protein sources and healthy fats. Aim to reduce highly processed options and foods high in fat, sugar, energy and salt, which will help reduce insulin resistance and type 2 diabetes risk.
3. Being active every day 鈥� Physical activity helps reduce insulin resistance by making the muscles thirsty for glucose. As a general guide, aiming for 30 minutes of exercise per day will assist in ongoing management of blood glucose levels. Seeking out the support of an Exercise Physiologist can be helpful in the post-partum period.
4. Aiming for a healthy weight 鈥� As a new mum it can be tricky to engage in health-gaining behaviours such as moving more, enjoying healthy food choices and getting sleep when you can etc, which can all result in weight changes. It is important to encourage women to aim as best they can to engage in health-gaining behaviours when and where they can, regardless of weight shifts, as these behaviours may help to reduce the future risk of type 2 diabetes or future GDM pregnancies.

Planning another pregnancy?

• Continue to follow the steps provided above.
• All women need to get tested earlier in the pregnancy, usually before 16 weeks and or when the nausea dies down.
• If you have already been diagnosed with pre-diabetes or type 2 diabetes it is also highly recommended to consider the following:

1. See the Doctor/GP 3-6 months before planning another pregnancy (see booklet page 27 for checklist to assist planning a pregnancy with type 2 diabetes).
2. Once pregnant, be referred to a specialist for close monitoring during the pregnancy.

For more information please refer to the NDSS or call the National Diabetes Services Scheme (NDSS) Helpline on 1800 637 700.

By Linda Uhr, Diabetes NSW & ACT Accredited Practising Dietitian & Diabetes Educator

Cassie shares her personal account with gestational diabetes. After being diagnosed and feeling upset that there would be complications through her pregnancy, Cassie’s journey includes the changes she and her partner made and the outcomes they experienced.

What was your first reaction to being diagnosed with gestational diabetes? How did you feel right away, and did that change at all as your pregnancy went on?

To be honest I was quite angry and upset when first diagnosed. We had already had difficulties through the pregnancy and I was upset to think there would be more. As I adjusted to the changes though, it became much easier and I realised it wasn’t as restrictive as I had first thought! I actually ended up enjoying it, as I was eating lots of fresh fruit and vegetables (which we didn’t before due to cost).

What worked for you to keep your blood glucose levels in your target range? Did you do exercise, or change some of the foods you ate?

I made a lot of changes to my lifestyle and so did my partner. We had to completely overhaul our sleeping routine, our eating routine and I had to add in exercise. We went from sleeping from 2am to 12pm to 11pm to 7 or 8am. We went from eating 1-2 meals a day and snacking on chips/lollies/chocolate to eating 3 very well-balanced meals and snacks! I added in some exercise (10mins of walking on the spot watching YouTube after meals usually, or housework) and tried to drink plenty of water. I did end up on insulin for fasting numbers, however my meal numbers were always within range.

Where did you get your information from about gestational diabetes?

Most of my information came from the internet to be honest. I did get some basic information from my hospital team however I found much more informative studies etc online. I have always been very good at sourcing information so I enjoyed doing it.

Did your doctor or diabetes educator talk to you about medications like tablets or insulin? If you took them, how did you find it? (About 40% of women with GD take medications for it)

I was able to do an information session on insulin once it was prescribed for me. They explained how to inject, how to store etc. I was given plenty of time to try and help my fasting levels with lifestyle changes first. Next time, I would just take the insulin straight away, as it was much less stressful and for all the effort I put in to change my fasting numbers nothing worked. Honestly, injecting insulin was easier than the finger pricks! It was simple and effective.

Did you find any positives to the diagnosis? Like getting more frequent scans or feeling more motivated to take good care of yourself?

I did lose a lot of weight. At 34 weeks I was under my pre-pregnancy weight! I honestly felt a lot better overall. I also learnt a lot about food, how it works in your system, how its processed. I still look at the carb content for everything I pick up in the supermarket. It鈥檚 fascinating stuff! More frequent scans were also wonderful.

What would you say to another woman who鈥檚 just been diagnosed with gestational diabetes?

It’s not your fault. You didn’t cause this. Doing your best to manage your GD will lower any risk to baby. Don鈥檛 stress about scans, they are often very inaccurate. Follow the diet, but don鈥檛 be too strict on yourself. It’s honestly not as awful as it feels to start with.

My biggest tips would be:

• Always balance your carbs with plenty of protein, good fats, and fibre. These help reign in the carbs.
• Get a good sleep and eating routine worked out.
• Drink plenty of water.
• Exercise for 10 mins after each meal.
• Always wash your hands before testing.
• Track EVERYTHING!

Cassie shares her personal聽gestational diabetes journey. After being diagnosed and feeling upset that there would be complications through her pregnancy, Cassie鈥檚 journey includes the changes she and her partner made and the outcomes they experienced.

What was your first reaction to being diagnosed with gestational diabetes? How did you feel right away, and did that change at all as your pregnancy went on?

To be honest I was quite angry and upset when first diagnosed. We had already had difficulties through the pregnancy and I was upset to think there would be more. As I adjusted to the changes though, it became much easier and I realised it wasn鈥檛 as restrictive as I had first thought! I actually ended up enjoying it, as I was eating lots of fresh fruit and vegetables (which we didn鈥檛 before due to cost).

What worked for you to keep your blood glucose levels in your target range? Did you do exercise, or change some of the foods you ate?

I made a lot of changes to my lifestyle and so did my partner. We had to completely overhaul our sleeping routine, our聽eating routine聽and I had to add in聽exercise. We went from sleeping from 2am to 12pm to 11pm to 7 or 8am. We went from eating 1-2 meals a day and snacking on chips/lollies/chocolate to eating 3 very well-balanced meals and snacks! I added in some exercise (10 minutes of walking on the spot after meals usually, or housework) and tried to drink plenty of water. I did end up on insulin for fasting numbers, however my meal numbers were always within range.

Where did you get your information from about gestational diabetes?

Most of my information came from the internet to be honest. I did get some basic information from my hospital team however I found much more informative studies etc online. I have always been very good at sourcing information so I enjoyed doing it.

Did your doctor or diabetes educator talk to you about medications like tablets or insulin? If you took them, how did you find it? (About 40% of women with GD take medications for it)

I was able to do an information session on insulin once it was prescribed for me. They explained how to inject, how to store etc. I was given plenty of time to try and help my fasting levels with lifestyle changes first. Next time, I would just take the insulin straight away, as it was much less stressful and for all the effort I put in to change my fasting numbers nothing worked. Honestly, injecting insulin was easier than the finger pricks! It was simple and effective.

Did you find any positives to the diagnosis? Like getting more frequent scans or feeling more motivated to take good care of yourself?

I did lose a lot of weight. At 34 weeks I was under my pre-pregnancy weight! I honestly felt a lot better overall. I also learnt a lot about food, how it works in your system, how it’s processed. I still look at the carb content for everything I pick up in the supermarket. It鈥檚 fascinating stuff! More frequent scans were also wonderful.

What would you say to another woman who鈥檚 just been diagnosed?

It鈥檚 not your fault. You didn鈥檛 cause this. Doing your best to manage your GD will lower any risk to baby. Don鈥檛 stress about scans, they are often very inaccurate. Follow the diet, but don鈥檛 be too strict on yourself. It鈥檚 honestly not as awful as it feels to start with.

My biggest tips would be:

• Always balance your carbs with plenty of protein, good fats, and fibre. These help reign in the carbs.
• Get a good sleep and eating routine worked out.
• Drink plenty of water.
• Exercise for 10 mins after each meal.
• Always wash your hands before testing.
• Track EVERYTHING!

Women and type 2 diabetes, is there a risk after GDM? Scientists have identified metabolites in the blood that accurately predict whether a woman will develop type 2 diabetes after experiencing gestational diabetes during pregnancy.

This discovery could lead to a test that would help doctors identify patients at greatest risk and help them potentially avert the condition through interventions including diet and exercise.

Michael Wheeler, Senior scientist at Toronto General Hospital Institute said, 鈥淭here is a metabolic dysregulation that occurs in the group of women that will go on to develop type 2 diabetes that is present in the early postpartum period. This suggests there is an underlying problem that exists already and we can detect it.鈥�

The identified metabolic signature can predict with over 85% accuracy if a woman will develop type 2 diabetes, as described in a study published in the journal聽

Gestational diabetes

In America, 1 in 10 women will develop聽gestational diabetes聽during pregnancy. In Australia the figure 1 in 7. This puts these women at higher risk of developing type 2 diabetes.聽 Between 30 to 50% will develop type 2 diabetes within 10 years after delivery.

聽diabetes hampers the body鈥檚 ability to regulate blood glucose levels and can lead to serious聽complications聽including vision loss, neurological problems, as well as heart and kidney disease.

Women with gestational diabetes聽are recommended to have an annual oral glucose tolerance test after delivery, which measures the body鈥檚 ability to remove glucose from the bloodstream. Fewer than half of all women follow through with it.

鈥淚f you鈥檝e got a newborn at home one of the last things you are thinking about or have time for is your own health,鈥� says Wheeler. 鈥淭his is one of the main reasons why we performed this study, to potentially develop a simple blood test reducing the number of hospital visits.鈥�

About the research

Wheeler and Gunderson first uncovered metabolic signatures predictive of type 2 diabetes in their 2016 SWIFT pilot study of 1033 women. All of the women delivered their babies between 2008 and 2011.

The new study builds on this prior research, following the same cohort of women over a longer time period during which more women developed type 2 diabetes.

Baseline blood samples were collected between six and nine weeks after birth and then twice over two years. The women鈥檚 health was followed through their electronic medical records for up to 8 years. During this time, 173 women developed type 2 diabetes and their blood samples were compared to 485 women enrolled in the study, matched for weight, age, race and ethnicity, who had not developed the disease.

鈥淭his study is unique as we are not simply comparing healthy people to people with advanced disease,鈥� says R枚st, who led the statistical data analysis. 鈥淚nstead, we are comparing women who are clinically the same鈥搕hey all had gestational diabetes but are back to living without diabetes after the birth of their child.

鈥淭his is the holy grail of personalized medicine to find molecular differences in seemingly healthy people and predict which ones will develop a disease,鈥� says R枚st.

R枚st said that, unsurprisingly, sugar molecules feature prominently among the identified compounds. But amino-acids and lipid molecules are also present, indicating underlying issues in protein and fat metabolism, respectively. In fact, the predictive power of the test dropped if amino-acids and lipids were excluded, suggesting that processes beyond sugar metabolism may occur very early in the development of the disease. The finding may help explain why complications occur in type 2 diabetes patients even when聽聽is tightly controlled with medications.

What鈥檚 next for women and type 2 diabetes after GDM?

The researchers hope to turn their discovery into a simple blood test that women could take soon after delivery, perhaps during an early visit to the doctor with their baby.

The women from the SWIFT study are being invited back for a 10-year follow-up visit, where they will be tested for type 2 diabetes. 鈥淭he information we glean from this study will bring us even closer to our goal of developing this blood test,鈥� says Gunderson. 鈥淚t will also help us to identify metabolic differences among race and ethnic groups that this test will need to take into account. The test is intended to help obstetricians and primary care providers identify the women with recent gestational diabetes who are most at risk for developing type 2 diabetes and to support them with breastfeeding and other healthful lifestyle habits during the first year postpartum that may reduce their risk.鈥�

Crystal’s story on how she discovered and managed her gestational diabetes.

It was my first pregnancy and due to my age (over 35 years) and high BMI I was booked in to have a glucose test at 15 weeks. Everything was fine at my first test but when I went in for the 28 week test I was 0.1 over. I was so mad because I had been really careful about what I was eating. I was convinced the only reason I was over was because I鈥檇 eaten a grape that morning. I had such bad morning sickness before the test that I just had to eat something, so I ate one grape. And then my result was over.

I was really upset and emotional after I got the result, so much so that when I jumped into my car I accidently drove into a pole! In shock I quickly reversed鈥� and hit another one. I burst into tears and had to phone my husband to drive over from work and get me. I hadn鈥檛 even told him about the diagnosis at this point because it was all such a mess. When we got home I burst into tears again. I was just devastated.

At first I blamed myself and didn鈥檛 want to tell anyone. I felt really embarrassed, upset and emotional. I started going to the health education sessions and was taught how to test and was told I had to monitor my blood four times a day. I was overwhelmed by the amount of information we received. A lot of it seemed alarmist and I came away feeling more scared than supported.

Even a visit to an endocrinologist didn鈥檛 put my mind at rest because he told me to take Metformin but also said the drug could cross the placenta and possibly cause issues with the baby. I came away confused and slightly annoyed that I鈥檇 paid all that money to a specialist but ended up with more questions than answers.

I decided not to take the tablets and to try and manage through exercise and diet. I was 32 weeks by this time.

The health educators actually frightened us quite a bit by saying if we had readings that were over our targets more than three times in a row we had to ring them or come in. At the time I was in a high stress job as an HR Manager, working long hours, five days a week. I couldn鈥檛 just nip out of meetings to test and rush off to the hospital if my readings weren鈥檛 quite right. It was a stressful time because I was so busy at work and so overwhelmed with doctor鈥檚 appointments. I was also told my baby might have to be taken away immediately after birth and that I would need to express colostrum prior to the birth so they could test it. I was really scared by this threat and said to my husband we might never see our baby. I didn鈥檛 feel supported at all, just anxious.

I managed perfectly well with monitoring myself through food and exercise but a month before my due date my waters broke and I had to go into hospital. I was given a steroid for the baby which affected my glucose levels and meant I had to go onto insulin for the last couple of weeks. I was in hospital for a week but when I got home I found I had an infection because my waters had broken, so I went back in again and was told I had to give birth right away. I was induced and he was 3.1kg at birth. So had I gone full term he could have been quite a big baby. Thankfully he wasn鈥檛 taken away from me after the birth and my glucose levels returned to normal straight away. My gorgeous little boy is now a healthy, happy 18-month-old.

My advice to women going through it is to attend all the education sessions so you understand what to eat and drink to keep your glucose levels consistent. Keep a record of what you eat and how it affects your readings. You might be surprised about what foods make your readings high and what doesn鈥檛. You may need to tell your manager at work so they understand that additional appointments are required. Try not to worry too much. You鈥檙e doing a great job.

, ; , , and , 

Despite its prevalence, most people aren’t aware that gestational diabetes risks don’t end when pregnancy does. In Australia 12-14% of pregnancies are affected by gestational diabetes.

Diabetes occurs when the level of glucose (sugar) in the blood is higher than normal. Cells in the pancreas control blood glucose levels by producing insulin. When these cells are destroyed, type 1 diabetes results. When the body becomes resistant to the action of insulin and not enough insulin can be made, this is known as type 2 diabetes.

Resistance to insulin action occurs for many reasons, including increasing age and body fat, low physical activity, hormone changes, and genetic makeup.

Gestational diabetes occurs when high blood glucose levels are detected for the first time during pregnancy. Infrequently, this is due to previously undiagnosed diabetes. More commonly, the diabetes is only related to pregnancy. Pregnancy hormones reduce insulin action and increase insulin demand, in a similar way to type 2 diabetes, but usually after the baby is born, hormones and blood glucose levels go back to normal.

Who gets gestational diabetes?

Factors that increase the risk of gestational diabetes include:

• a strong family history of diabetes
• weight above the healthy range
• non Anglo-European ethnicity
• being an older mum.

Weight is the major risk factor that can be changed. But in some cases, gestational diabetes may develop without any of these risk factors.

Rates of gestational diabetes in Australia have approximately doubled in the last decade. Increased testing for gestational diabetes, changing population characteristics, and higher rates of overweight and obesity may have contributed to this. There are likely to be other factors we do not fully understand.

All women with a history of gestational diabetes should have a yearly medical check-up.

Ongoing effects

If gestational diabetes is not well managed, there鈥檚 greater risk of complications during pregnancy and childbirth for both mother and baby, including high blood pressure, premature birth, having a large baby, or needing a caesarean section. With good pregnancy care, healthy eating, physical activity and the use of medications such as insulin or metformin (which controls high blood pressure) where needed, many of these problems can be avoided.

A blood test six to twelve weeks after childbirth can confirm if the diabetes has gone away. After this it can be tempting to forget about the gestational diabetes altogether. Unfortunately, however, we know this is not necessarily the end of the diabetes journey.

In recent years, we鈥檝e realised women with gestational diabetes have a higher risk of developing health problems later in life. Pregnancy is a special kind of 鈥渕etabolic test鈥�. It unmasks potential problems of resistance to insulin action, or inadequate insulin production which were hidden before pregnancy.

The risk of type 2 diabetes in women who have had gestational diabetes is up to  of women who haven鈥檛.

Compared to women without gestational diabetes, the risk of developing  and  is nearly tripled.

 children of gestational diabetes pregnancies have higher risk of being overweight and having diabetes as they grow up. , diabetes was increased up to four times. As more women are having gestational diabetes, this could be one contributor to escalating rates of diabetes and obesity, especially in young people.

Changing the future of gestational diabetes risks after pregnancy

Gestational diabetes should be seen as an opportunity to identify families at higher risk of metabolic problems and take action. All women with a history of gestational diabetes should have a yearly medical check-up and management of weight, blood pressure, cholesterol, and other risk factors for heart disease.

 testing for diabetes every one to three years, depending on risk. Knowing a woman鈥檚 diabetes status before her next pregnancy is important.

We need to better understand who is at highest risk and research which interventions will reduce that risk. In the meantime, those in health care should recommend lifestyle changes that reduce body fat, such as healthy eating and physical activity. These changes can be adopted by the whole family.

Women should aim to lose the excess weight gained during pregnancy and be within or closer to their healthy weight range.  for preventing weight gain and potentially even diabetes.

Gestational diabetes is a window into the future health of women and their children. With appropriate education, support, monitoring and preventative action, this glimpse into the future allows us to change our destiny.

, Dietitian/Clinical Trial Manager, ; , Endocrinologist, , and , Reseach Trial Manager/Midwife, 

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