Gestational Diabetes

Introduction 

Gestational diabetes is a type of diabetes that affects women during pregnancy. Diabetes is a condition where there is too much sugar in the blood. Normally, the amount of glucose in the blood is controlled by a hormone called insulin. However, during pregnancy, some women have higher than normal levels of glucose in their blood and their body cannot produce enough insulin to transport it all into the cells. This means that the level of glucose in the blood rises.

How common is gestational diabetes?

Two to five in every 100 women giving birth has diabetes. Most of these women have gestational diabetes, and some have type 1 or type 2 diabetes.

Outlook

Gestational diabetes can be controlled with diet and exercise. However, some women with gestational diabetes will need medication to control blood glucose levels. If gestational diabetes is not detected and controlled, it can increase the risk of birth complications, such as babies being large for their gestational age. In most cases, gestational diabetes develops in the third trimester and usually disappears after the baby is born. However, women who develop gestational diabetes are more likely to develop type 2 diabetes later in life.

Gestational diabetes often doesn't have any symptoms, but you may:

- feel tired

- have a dry mouth

- be very thirsty

- wee a lot

- get recurring infections, such as thrush

have blurred vision

If you have any of these symptoms, tell your midwife or doctor.

Risk factors

You may be at increased risk of gestational diabetes if:

your body mass index (BMI) is 30 or more

you have previously had a baby who weighed 10lbs or more at birth 

you have a family history of diabetes/ one of your parents or siblings has diabetes

Your baby may be at risk of: 

stillbirth

health problems shortly after birth (such as heart and breathing problems) and needing hospital care

developing obesity or diabetes later in life

Diagnosis

The oral glucose tolerance test (OGTT) can be used to test for GDM. The current National Institute for Health and Care Excellence (NICE) guidance recommends that:Woman who have had GDM in a previous pregnancy should be offered early self-monitoring of blood glucose or a two-hour 75 g OGTT at 16-18 weeks, followed by a repeat OGTT at 28 weeks of pregnancy if the first test is normal.Women with other risk factors should have an OGTT at 24-28 weeks.

Treatment 

Your diabetic treatment is likely to need adjusting during your pregnancy, depending on your needs. If you take drugs for conditions related to your diabetes, such as high blood pressure, these may have to be altered.

It's very important to keep any appointments that are made for you, so that your care team can monitor your condition and react to any changes that could affect your own or your baby's wellbeing.

Expect to monitor your blood glucose levels more frequently during pregnancy. Your eyes and kidneys will be screened more often to check that they are not deteriorating in pregnancy, as eye and kidney problems can get worse. You may also find that as you get better control over your diabetes, you have more low blood sugar attacks. These are harmless for your baby, but you and your partner need to know how to cope with them. 

Controlling gestational diabetes

Gestational diabetes can often be controlled by diet. A dietitian will advise you on how to choose foods that will keep your blood sugar levels stable. You'll also be given a kit to test your blood glucose levels. If your blood sugar levels are unstable, or your baby is shown to be large on an ultrasound scan, you may have to take tablets or give yourself insulin injections.

Labour and birth

If you have diabetes, it's strongly recommended that you give birth with the support of a consultant-led maternity team in a hospital. 

Depending on how your pregnancy is going, you may be offered induction of labour or caesarean section, between 38 weeks and 40 weeks. Another option from 38 weeks is to wait for labour to start naturally but to have regular scans. These scans will check how your baby is doing and check the blood supply from the placenta. 

After the birth

Two to four hours after your baby is born, they will have a heel prick blood test to check whether their blood glucose level is too low. Feed your baby as soon as possible after the birth usually within 30 minutes to help keep your baby's blood glucose at a safe level. If your baby's blood glucose can't be kept at a safe level, they may need extra care. Your baby may be given a drip to increase their blood glucose. 

When your pregnancy is over, you won't need as much insulin to control your blood glucose. You can decrease your insulin to your pre-pregnancy dose or, if you have type 2 diabetes, you can return to the tablets you were taking before you became pregnant. Talk to your doctor about this. If you had gestational diabetes, you can stop all treatment after the birth. You should be offered a test to check your blood glucose levels before you go home and at your six-week postnatal check. You should also be given advice on diet and exercise.

Anti-Bullying

Many children and young people experience school bullying and bullying outside of school but you don't have to put up with it. Almost half of all children and young people say that they've been bullied at some point during their time at school. 

What is bullying?

Bullying can take many forms: from teasing and spreading rumours, to pushing someone around and causing physical harm. It often happens in front of other people. It includes name calling, mocking, kicking, taking belongings, writing or drawing offensive graffiti, messing around with people’s belongings, gossiping, excluding people from groups, and threatening others.

Why are people bullied?

Children and young people are bullied for all sorts of reasons. It can be due to their race, their religion, their appearance, their sexual orientation, because they have a disability or because of their home circumstances. 

Cyberbullying is increasingly common both inside and outside school. Cyberbullying is any form of bullying that involves the use of mobile phones or the internet. 

The effects of bullying

Bullying makes the lives of its victims miserable. It undermines their confidence and destroys their sense of security. Bullying can cause sadness, loneliness, low self-esteem, fear, anxiety, and poor concentration, and lead to self-harm, depression, suicidal thoughts and, in some cases, suicide. Bullying can also affect children and young people's attendance and progress at school.

Getting teenagers to talk openly about what's bothering them can be hard. Follow these tips to help get them talking to you about their worries.

1. Ask, don’t judge

2. Ask, don’t assume or accuse

3. Be clear you want to help

4. Be honest yourself

5. Help them think for themselves

6. Don’t criticise everything

7. If they get angry, try not to react

8. Make them feel safe

Knowing or suspecting that your child is being bullied can be very upsetting, but there are many things you can do to resolve the problem. Bullying is one of the biggest concerns for parents. If you find out or suspect that your child is being bullied, there are things you can do to resolve the problem. 

How to help your child if they are being bullied

If a child tells you they’re being bullied, the first thing to do is listen. The NSPCC advises you to suggest to your child that they keep a diary of bullying incidents. It will help to have concrete facts to show the school. The next step is to talk to the school 

How do you know if your child is being bullied?

Sometimes children don’t talk to their parents or carers because they don’t want to upset them, or they think it will make the problem worse. However, if you suspect that your child is being bullied, there are signs to look out for. These include:

Coming home with damaged or missing clothes, without money they should have, or with scratches and bruises.

Having trouble with homework for no apparent reason.

Using a different route between home and school.

Feeling irritable, easily upset or particularly emotional.

Talking to the school about bullying

To stop the bullying, it's essential for you or your child, or both of you, to talk to the school. Think about who would be the best person to approach first. Discuss this with your child because there may be a particular teacher your child feels more comfortable with. 

It's worth asking about any school schemes to tackle bullying, such as peer mentoring where certain children are trained to listen and help with problems. You could ask to see the school’s anti-bullying policy, which every school has to have by law. This will enable you to see how the school plans to prevent and tackle bullying.

Who can help with bullying?

All the organisations listed below provide support and information to parents.

Family Lives

Bullying UK

Kidscape

NSPCC

Childnet International

Contact a Family

Cyberbullying is the use of technology such as mobile phones and the internet to bully other people. Coping with cyberbullying can be difficult because it can happen at any time of the day.

What is cyberbullying?

Emailing or texting threatening or nasty messages to people.

Posting an embarrassing or humiliating video of someone on a video-hosting site such as YouTube.

Harassing someone by repeatedly sending texts or instant messages in a chat room.

Setting up profiles on social networking sites, such as Facebook, to make fun of someone.

'Happy slapping', which is when people use their mobiles to film and share videos of physical attacks.

Posting or forwarding someone else's personal or private information or images without their permission.

Sending viruses that can damage another person’s computer.

Making abusive comments about another user on a gaming site.

How to respond to cyberbullying

Do

Talk to someone you trust. This could be a teacher, parent, carer or friend. Schools have a responsibility to ensure that students aren’t bullied, and they can take action even if the bullying is happening outside school. 

Report the bullying to the internet service provider if the bullying happened online. Ask a parent or teacher for help.

Report the bullying to your mobile phone provider if you’ve received bullying texts or calls on your mobile. You may even have to change your number if you're repeatedly bullied through your phone.

Block instant messages and emails. Ask a parent or teacher for help. 

Report serious bullying, such as physical or sexual threats, to the police.

Don't

Don’t delete the upsetting emails or messages. Keep the evidence. This will help to identify the bully if the bullying is anonymous. Even people who use a false name or email can be traced.

Don’t reply. This is what the bully wants, and it might make things worse.

How to avoid being cyberbullied

The best way to avoid being cyberbullied is to use the internet and mobile phones carefully.

Don’t give out personal details, such as your phone number or address, in a chat room.

Think carefully before posting photos or videos of you or your friends.

Only give your mobile number to close friends.

Protect passwords, and never give your friends access to your accounts.

Don’t forward nasty emails.

Learn how to block instant messages or use mail filters to block emails.

Congenital Heart Defect (CHD)

Heart defects are one of the most common birth defect. They are the leading cause for birth defect deaths. It's estimated 9 out of 1000 people are born with a congenital heart defect. Many heart defects do not need treatment, but some complex congenital heart defects require medication or surgery.

***********

To help understand Congenital Heart Defects we think explaining how the heart works first will help.

The Heart:

Your heart is a muscular organ. It has four chambers that are designed to pump blood around your body. When a heart is formed properly there are  two large chambers (ventricles) and two receiving chambers (atria) For those with a Congenital Heart Defect things arent formed like they should be meaning the heart cannot work as it should.

***************

The Definition of Congenital Heart Defects

Congenital means ‘born with’ or ‘from birth’. Sometimes a Congenital Heart Defect could be left unnoticed until adulthood, but most are detected at birth. Most of these defects can become corrected with surgery.

************

What are Congenital Heart Defects?

Congenital Heart Defects occur soon after conceptio & the heart forms abnormally. These defects can range from very severe malformations, eg. complete absence of one or more chambers or valves or simple problems eg. holes between chambers of the heart.

***********

How are Congenital Heart Defects Detected?

Congenital Heart Defects can sometimes be picked up when you have an ultrasound scan during pregnancy (usually at the 20 week scan), but sometimes they are not found until after your baby has been born. Some conditions may not be discovered until the child is older or even an adult.

************** ME ***********

Signs and Symptons

Signs & Symptoms in a Newborn

There may be few or no symptoms for a newborn with a Congenital Heart Defect. The defect may or may not have been picked up on your scans.

These signs and symptoms can sometimes occur in Newborn Babies with A Congenital Heart Defect:

A bluish tint to the skin, lips, and fingernails also known as Cyanosis

Poor circulation

Fast or difficult breathing

Tiredness

Finding feeding hard

Poor blood circulation

************

There are 35 known Congential Heart Defects and a whole list of other things that can affect the heart. The most common include:

Aortic Stenosis

Atrial Septal Defect

Atrio-ventricular Septal Defect

Cardiomyopathy

Ebstein’s Anomaly

Eisenmenger Syndrome

Pulmonary Stenosis

Tetralogy of Fallot

Transposition of the Great Arteries

Ticuspid Atresia

Truncus Ateriosus

Ventricular Septal Defect

************

Congenital Heart Defects are the number 1 birth defect in UK & are a main cause of loss during pregnancy.

Many people know nothing about heart defects until they have a child born with one.

These defects are not something that can be cured, the heart will have to be monitored through the persons life. 

Many will need multiple open heart surgeries and in some cases they may even need a heart transplant.

Babies born with Congenital Heart Defects will most likely need open heart surgery at just a few hours or days old.

*******

Treatment of Congential Heart Defects 

Each person who has a Congential Heart Defect is similar to the next but are unique in the fact that they are effected differently. 

There are many surgeries used to help repair the heart, where doctors try to prevent the need for further surgery.

People who have Congential Heart Defects will be monitored throughout their lives for any further problems

 

***********

Congenital Heart Defect Facts

In the UK there are about 4,600 babies born with congenital heart defects each year

The outlook for babies born with congenital heart defects has improved dramatically over the past 30 years

At least three-quarters of babies with congenital heart defects are predicted to survive to adulthood

The outlook for babies born with congenital heart defects varies widely depending on the complexity of the defect. Survival rates in a number of simple conditions are close to 100%

Around 3100 operations and 725 interventional cardiac catheterisations are performed each year on babies and children with congenital heart defects

************

As we have said before Congential Heart Defects aren't curable. This means that in some cases their is nothing more the doctors can do. In others the person may live a full life not knowing there is anything wrong. 

The awareness of Congenital Heart Defects is low & you probably didn't know anything about it until now but we hope the information we have provided has helped a few people learn a little more

Thank you for joining us tonight

Normal PP's will resume shortly

Lauren, Jade & Tessa xx

www.nhs.uk 

www.chd-uk.co.uk

Group B Streptococcus

What is Group B Streptococcus?

Group B Streptococcus (GBS, or group B strep) is a bacteria carried by updating I to 30% of people, but it doesn't usually cause harm or symptoms. In women, it is found in the intestine and vagina. It causes no problem in most pregnancies. In a small number of pregnancies, it infects the baby, usually just before or during labour, leading to serious illness.

Though it's rare, GBS is the most common cause of severe infection in newborns, particularly in the first week after birth.

************

Could I be carrying GBS?

If you are carrying GBS you probably won't even know it. This is because there aren't usually any symptoms. You could discover that you have GBS by chance, when having a vaginal swab taken to check for something else. There is a test available for GBS, but it's not routinely carried out in pregnancy due to concerns about its reliability. 

*************

Pregnancy & GBS

Roughly 1 in 2,000 babies in the UK develops a GBS infection shortly after being born. Sadly, about 1 in 10 of these babies dies. It's a very rare event when a baby does not survive a GBS infection but sadly it does happen. 

It isn't known why some babies develop an infection and others don't. What is clear is that most GBS infections in newborn babies can be prevented. 

**********

Most pregnant women who carry GBS bacteria have healthy babies. However, there’s a small risk that GBS can pass to the baby during childbirth. 

Rarely, GBS infection in newborn babies can cause serious complications that can be life threatening.

Extremely rarely, GBS infection during pregnancy can also cause miscarriage, early (premature) labour or stillbirth.

**********

What Happens If I Have GBS?

When you go in to labour, if you are in a high-risk group (listed below) your doctor will give you antibiotics via a drip in your arm. This is to reduce the risk of your baby developing a GBS infection. These are given from the start of your labour, or from when your waters break, right up to your baby's birth. 

If you are given antibiotics, they will need to be taken at least two hours before your baby is born.

As always there are some risks and drawbacks taking antibiotics in labour for you & your child. Your doctor will discuss your case with you.

There are a number of factors that help to predict whether your baby is likely to develop a GBS infection. (If you carry GBS)

These include:

If you go into labour prematurely (before 37 weeks of pregnancy)

If your waters break 18 hours or more before you have your baby

If you have a fever of 38 degrees C or higher during labour

If you have previously had a baby infected with GBS

If you carry GBS in your vagina and/or rectum during your pregnancy

If GBS has been found in your urine during your pregnancy

Having a caesarean is not a method of preventing GBS infection in babies. This is because having a caesarean doesn't eliminate the risk of GBS being passed on to your baby. 

******* 

What Happens After Birth?

If you don't fall into one of the high-risk groups & your had the drip for at least 2 hours before giving birth, your baby is unlikely to develop a GBS infection.

If your baby is at higher risk of developing a GBS infection once they are born, they will be examined by a paediatrician.

Several factors decide whether or not you or your baby are given antibiotics:

If both you and your baby are completely healthy, and you had full treatment with antibiotics during labour, you baby won't need antibiotics.

If you are both healthy, but you didn't have antibiotics during labour, your baby may be started on antibiotics until given the all-clear.

If you or your baby shows signs of a GBS infection, your baby should be started on antibiotics without delay.

*********

Doctors are still researching the best way to treat newborns at risk of a GBS infection. That's why you may or may not receive antibiotics as your treatment. It may also depend on your hospital's policy and your own circumstances.

You and baby might be treated with penicillin without any side effects. Side effects include a rash, diarrhoea and nausea. These are minor, though penicillin may affect the balance of bacteria in baby's tummy. 

If you are known to be allergic to penicillin you will be given another antibiotic instead, called clindamycin.

These side effects make some doctors wary about using antibiotics particularly for newborns. Some doctors prefer to wait for the first 12 hours after the birth before starting a course of antibiotics, in case there's no need.

********

What Are The Signs Of A GBS Infection In My Baby?

GBS infections in babies would usually happen within seven days of birth (early onset), with 90% occurring within 24 hours of your babies birth.

Typical signs of early-onset GBS infection in babies include:

Grunting

Poor feeding

Lethargy (Tiredness)

Irritability

Low Blood Pressure

Abnormally high or low temperature

Abnormally high or low heart rate or breathing rate

GBS infections can also develop when a baby is seven or more days old (late-onset), though it's not common. 

*********

GBS bacteria can cause bacterial meningitis, though late onset infections tend to be less severe than early onset infections. Most babies respond well to treatment, though meningitis can leave some babies with long term problems. 

GBS infections in babies are rare after they're one month old and are virtually unheard-of once they're over three months old.

**********

Why isn't there a national screening programme for GBS?

There's conflicting evidence and differing views about whether a national screening programme for GBS would be effective. 

Many experts believe that a screening programme would do more harm than good. If antibiotics are used too widely, bacteria may become resistant to antibiotics in the future. And interventions in pregnancy when it's not necessary may also do more harm than good. 

However, the charity Group B Strep Support continues to campaign for a GBS national screening programme.

*********

I'm carrying GBS. What happens next?

If you have been affected by GBS in a previous pregnancy, or are carrying it in your current pregnancy, talk to your midwife or obstetrician. You can then discuss a birth plan that includes steps to protect your baby from the infection. 

If you have GBS in your current pregnancy, a hospital birth will be recommended, so you can have antibiotics if you need them. 

Your pregnancy will then be managed so your baby is as protected as possible.