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A - MSRA Obstetrics [16] > [21] Gestational Diabetes > Flashcards

[21] Gestational Diabetes Flashcards

1
Q

What is gestational diabetes mellitus (GDM)?

A

Any degree of glucose intolerance with its onset during pregnancy and usually resolving shortly after delivery

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2
Q

What tests do NICE recommend to use for diagnosing GDM?

A
  • Fasting plasma glucose

- Two-hour glucose tolerance test (GTT)

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3
Q

What level is recommended as diagnostic for GMD on fasting plasma glucose?

A

≥5.6 mmol/L

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4
Q

What level is recommended as diagnostic for GDM on GTT?

A

≥7.8 mmol/L

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5
Q

How do pregnancy hormones change energy consumption and storage?

A
  • Decrease in fasting glucose levels
  • Increase in fat consumption
  • Delayed gastric emptying
  • Increased appetite
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6
Q

What happens to insulin resistance in pregnancy?

A

It rises

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7
Q

What happens to post-prandial glucose levels as insulin resistance increases in pregnancy?

A

They rise

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8
Q

How is increased insulin resistance countered in normal pregnancy?

A

Levels of insulin rise

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9
Q

What happens to levels of insulin in GDM in relation to insulin resistance of pregnancy?

A

They do not compensate as well as they need to

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10
Q

What are the risk factors for gestational diabetes?

A
  • Increasing age
  • Asian or African america ethnic group
  • High BMI before pregnancy
  • Smoking
  • Increase in weight between pregnancies
  • Short interval between pregnancies
  • Previous unexplained still birth
  • Previous macrosomia
  • Family history of T2DM or GDM
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11
Q

What are some protective factors against gestational diabetes?

A
  • Physical activity

- Bariatric surgery

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12
Q

What are the most common symptoms of gestational diabetes?

A

Most women have no symptoms

Those who do have typical DM symptoms

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13
Q

How are most women with gestational diabetes detected?

A

Screening

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14
Q

What does NICE recommend as indications for screening for GDM at booking?

A
  • BMI >30
  • Previous macrosomic baby (≥4.5kg)
  • Previous GDM
  • First-degree relative with DM
  • Family origin with high prevalence of diabetes e.g. South Asian, black Caribbean and middle eastern
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15
Q

After booking when should women be re-screened for gestational diabetes?

A

24-28 weeks

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16
Q

What test should be used to screen for GDM in women with risk factors?

A

2 hour oral GTT

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17
Q

Why is good glycaemic control in GDM important?

A

It seriously reduces perinatal morbidity

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18
Q

How can most women with GDM be managed?

A

With lifestyle modification

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19
Q

What lifestyle modifications can be useful in controlling GDM?

A
  • Weight loss
  • Diet
  • Physical activity
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20
Q

When is weight loss advisable in GDM?

A

When BMI is > 27

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21
Q

Who should give dietary advice to women with GDM?

A

Specialist dietician

22
Q

What should the food choices of a GDM diet reflect?

A

The nutritional demands of pregnancy

23
Q

What is the recommended level of physical activity for women with GDM?

A

At least 30 minutes a day of physical activity sufficient enough to induce slight breathlessness

24
Q

What is the first line medication for women with GDM who cannot control with lifestyle changes alone?

A

Metformin

25
Q

When should metformin be started for GDM?

A

If blood glucose targets aren’t met within 1-2 weeks

26
Q

When is insulin offered in GDM?

A
  • Metformin is contraindicated
  • Metformin is unacceptable to the woman
  • Metformin and lifestyle changes have not achieved good control
  • Fasting plasma glucose >7 mmol/L at diagnosis
  • Fasting plasma glucose 6-6.9 mmol/L at diagnosis with macrosomia or hydramnios
27
Q

What types of insulin are used in pregnancy?

A

Rapid acting insulin analogues (aspart and lispro)

28
Q

What risks should women treated for GDM with insulin be warned of?

A
  • Risk of hypoglycaemia

- Impaired awareness of hypoglycaemia especially in first trimester

29
Q

What should all women treated for GDM with insulin have available?

A

A fast-acting form of glucose e.g. dextrose tablets

30
Q

What should all women with GDM receive as part of their antenatal care?

A
  • Blood glucose monitoring
  • Target blood glucose
  • HbA1c monitoring
  • Fetal abnormality scan
  • Monitoring of fetal growth and well-being
31
Q

When should women with GDM test their blood glucose if they are lifestyle, metformin or single-dose of insulin?

A

Fasting and 1 hour post-meal every day

32
Q

When should women on multiple daily injections of insulin for GDM check their blood glucose levels?

A
  • Fasting
  • Pre-meal
  • 1 hour post-meal
  • Bedtime
33
Q

How should the target blood glucose levels be determined?

A

Through discussion with risk of hypoglycaemia taken into account

34
Q

What are the usual target for fasting blood glucose in GDM?

A

5.3 mmol/L

35
Q

What is the usual target 1 hour post-meal glucose in GDM?

A

7.8 mmol/L

36
Q

Why is measuring HbA1c important in GDM?

A

To identify those who may have had pre-existing T2DM

37
Q

When should HbA1c not routinely be measured in pregnancy?

A

In the 2nd and 3rd trimesters

38
Q

When should women with GDM receive a fetal structural abnormality scan?

A

At 20 weeks

39
Q

How often should women with GDM be offered USS fro assess fetal growth and amniotic fluid volume?

A

28-36 weeks

40
Q

Is GDM a contra-indication to antenatal steroids for fetal lung maturation or tocolysis?

A

No

41
Q

When should women with GDM not give birth after?

A

40+6 weeks

42
Q

How do women with GDM often deliver at 40+6 weeks?

A

Either by induced labour or C-section

43
Q

What should be considered when planning delivery in women with GDM and risks of maternal or fetal complications?

A

Elective birth before 40+6

44
Q

What should happen to GDM medication after birth?

A

Discontinue immediately

45
Q

What monitoring should women receive after birth for GDM?

A

Fasting plasma glucose test 6-13 weeks after birth to exclude diabetes

46
Q

If post-natal fasting blood glucose is <6 mmol/L what is the guidance?

A

Low probability of having diabetes but should continue to follow lifestyle advice and need annual review

47
Q

Why is important women who have had GDM continue to follow lifestyle advice and receive annual review if their post-natal fasting blood glucose is < 6mmol/L?

A

They are at higher risk of T2DM

48
Q

If post-natal fasting blood glucose is 6-6.9 mmol/L what is the guidance?

A

They are at high risk of T2DM and offer advice, guidance and interventions to prevent this

49
Q

If post-natal fasting blood glucose is ≥7 mmol/L what is the guidance?

A

They are likely to have T2DM and testing should be offered to confirm this

50
Q

What are the potential obstetric complications of GDM?

A
  • Macrosomia
  • Large for gestational age
  • Pre-eclampsia
  • Delivery by c-section
  • Shoulder dystocia
  • Birth injuries
  • Hypoglycaemia
51
Q

What birth injuries is a baby at risk of if their mother has GDM?

A
  • Bone fractures

- Nerve palsies

52
Q

What are the potential long-term health complications of GDM on mother and baby?

A

Sustained impairment of glucose tolerance

  • Subsequent obesity
  • Impaired intellectual achievement

A - MSRA Obstetrics [16] (61 decks)

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