Diabetes in Pregnancy Clinic

The Diabetes in Pregnancy Clinic at Fiona Stanley Hospital provides combined pregnancy and diabetes care to pregnant women with gestational diabetes.

If you have diabetes (external site) your blood glucose (blood sugar) levels can be too high. Gestational diabetes only occurs during pregnancy and can lead to increased risks for you and baby. It is usually diagnosed around 24 to 28 weeks of pregnancy and affects 1 in 7 pregnant women in Australia each year. Sometimes medications such as insulin or metformin are required to keep blood glucose levels in the safest range for a healthy pregnancy and baby.

Our care

Pregnancy can be exciting for many women, but sometimes when you have gestational diabetes it can feel particularly overwhelming. One benefit of our clinic is that by providing both pregnancy and diabetes care in one appointment we reduce your need to attend more hospital appointments.

Our Diabetes in Pregnancy team is committed to helping you throughout your pregnancy journey. Please feel free to ask any questions your may have, especially if you are feeling concerned.Our team

Our multidisciplinary team includes:

• obstetricians to oversee your pregnancy care
• midwivesto support your pregnancy journey and provide pregnancy and birth education
• endocrinologists (doctors who specialise in diseases affecting glands and hormones) to oversee blood sugar control and diabetes medications
• diabetes educators to support you to manage your diabetes in pregnancy
• dietitians who can advise you on a diet which minimises the effect of food on your blood glucose levels while keeping you and your baby well nourished.

Your clinic visits

At your first outpatient clinic visit you will meet with:

• an obstetrician or midwife
• an endocrinologist or diabetes educator
• a dietitian.

Please note this visit may take up to 3 hours.

You will then usually have appointments every 2 weeks until 36 weeks of pregnancy. Some appointments may be able to be safely delivered by telephone – the team will let you know if this is safe for you and your baby. From 36 weeks, visits are usually weekly until birth of your baby. The regular schedule of clinic visits is as follows:

• First visit (in person appointment) with an obstetrician, endocrinologist or diabetes educator and dietitian.
• 30 weeks (in person appointment) with a midwife.
• 32 weeks (phone appointment) with an obstetrician, endocrinologist or diabetes educator.
• 34 weeks (in person) with a midwife.
• 36 weeks (phone appointment) with an obstetrician, endocrinologist or diabetes educator. Book induction of labour for 39 weeks or earlier as needed.
• 37 weeks (in person appointment) with a midwife, endocrinologist or diabetes educator.
• 38 weeks (in person appointment) with a midwife, endocrinologist or diabetes educator.

It will also be recommended you have ultrasounds to check your baby’s growth at 28, 32 and 36 weeks.

Timing and method of birth

Throughout your care, your team will discuss with you:

• what to expect during labour and birth
• a plan to manage your blood glucose levels
• insulin adjustment (if relevant)
• who to contact if you go into labour earlier than expected.

It is usually recommended woman with gestational diabetes give birth by 39 weeks and your team will work with you to aim for a vaginal birth close to your due date.

An earlier birth may be recommended if there are concerns during your pregnancy, such as:

• high blood pressure
• pre-eclampsia (a serious condition of pregnancy, usually characterised by high blood pressure, protein in the urine and severe swelling)
• your baby growing too big or not growing enough.

If your labour has not started by 39 weeks, we usually recommend you be induced (using medications or other methods to start labour).

An elective caesarean section may be recommended, particularly if your baby is large.

An obstetrician will discuss both timing and birthing options with you. Please feel free to ask any questions your may have, especially if you are feeling concerned.

It is important to monitor your baby’s movements regularly

Feeling your baby move regularly is a sign that your baby is healthy.

Evidence shows that 50 per cent of women who had a stillbirth noticed their baby’s movements had slowed down or stopped.

If you notice your baby is moving less than usual or the movements are not as strong, phone the Maternal and Fetal Assessment Unit on 6152 4301 without delay. Please do not be concerned that you are wasting the midwives time, and do not wait until the next day or your next appointment.

Find out more about why your baby’s movements matter at Safer Baby (external site).

Learn more about healthy eating for gestational diabetes

Watch the presentation below on how to eat well to manage your gestational diabetes. You can watch the presentation in full or skip to a specific section by choosing from the list of chapter headings.

Skip to a chapter heading using the timings below:

• 0 mins 00 sec – Introduction
• 0 mins 50 sec – Carbohydrate foods and when to eat them
• 2 mins 12 sec – Carbohydrate metabolism
• 3 mins 36 sec – Healthier and low GI carbohydrate foods
• 5 mins 15 sec – Non-carbohydrate foods
• 5 mins 53 sec – Recommended carbohydrate intake
• 6 mins 49 sec – Reading food labels
• 7 mins 49 sec – Carbohydrate serving sizes
• 12 mins 15 sec – Example meals and snacks
• 14 mins 54 sec – Tips for larger appetites
• 15 mins 46 sec – Tips for smaller appetites
• 16 mins 53 sec – Gestational weight gain targets
• 18 mins 19 sec – Summary and conclusion

Referral

Faxed or eReferrals to this clinic are accepted from antenatal services within:

• Fiona Stanley Hospital
• Peel Health Campus
• Rockingham General Hospital
• Armadale Health Service.

Read the FSH Diabetes in Pregnancy Referral Form (PDF 152KB). Health professionals seeking more information should email FSH referrals.

Contact

Please phone the Fiona Stanley Hospital Antenatal Clinic on 6152 4012 or email the Diabetes in Pregnancy team.