Gestational diabetes (GDM) is defined by the International Diabetes Federation as “any degree of glucose intolerance with onset or first recognition during pregnancy”.

It affects up to 15 per cent of pregnant women worldwide and here in Bermuda it is estimated that 5 to 7 per cent of all pregnancies develop GDM. This number, however, is expected to rise.

The rise is directly related to the rising rates of obesity and type two diabetes.

Bermuda is following this trend as the results from the recently released Steps survey showed — almost three-quarters of Bermuda’s participants were either overweight or obese.

GDM is typically identified during the 24th and 28th week of pregnancy. If the glucose (sugar) levels are not brought under control it can result in serious complications for both mother and baby. Excess levels of maternal glucose can cause macrosomia (a large baby — more than 9lb in weight).

Complications can include pre-eclampsia, shoulder dystonia, resulting in a traumatic birth for mother and baby, stillbirth, neonatal respiratory syndrome and neonatal hypoglycaemia (low blood glucose).

GDM can also have a long-term health impact, with more than 50 per cent of women with GDM going on to develop type two diabetes within five to ten years of delivery.

Moreover, infants of women with GDM have a higher prevalence of being overweight and obese, and are at higher risk of developing type two diabetes later in life.

If GDM is well controlled, the outcomes for mother and baby are similar to that of a mother without GDM. The goal, therefore, is to maintain normal glucose levels. Management of GDM consists of healthy meal planning, exercise, glucose testing and glucose goals, medication and foetal monitoring.

Bermuda Hospitals Board has specialists who work closely with mothers, helping them to manage GDM.

At Bermuda’s only accredited programme, the Diabetes Respiratory Endocrine and Metabolism (Dream) Centre, diabetes nurse specialists and registered dietitians collaborate with endocrinologist Annabel Fountain and the mother’s obstetrician.

Individuals are assessed during a 90-minute interview and are followed weekly from the time of referral until delivery, to ensure the best possible outcomes for both mother and baby.

After delivery of a baby, a mother’s blood glucose levels return to normal as the body’s insulin requirements drop. However, as previously mentioned, 50 per cent of women with GDM go on to develop diabetes.

The goal of the centre is to follow up these mothers to reduce this rate by preventing diabetes developing later.

Six weeks after delivery all GDM women should have a repeat 75 gram, two-hour oral glucose tolerance test using non-pregnancy criteria and undergo screening for prediabetes or type two diabetes every year thereafter, as recommended by the National Institute for Health and Clinical Excellence in the UK.

Women should also be counselled on eating healthy, maintaining a regular exercise regime and achieving a healthy weight.

• This article is the first in a series organised by Bermuda Hospitals Board in honour of Diabetes and Chronic Obstructive Pulmonary Disease Awareness Month. Jane Hope is the clinical diabetes manager at King Edward VII Memorial Hospital’s Dream Centre. She has a passion for helping to improve the lives of all people with diabetes and has a special interest in managing women with GDM.