5: GDM

Question 1

Why is pregnancy diabetogenic?

Answer 1

Hormones secreted by the pancreas promote insulin resistance which begins around weeks 20-24 of pregnancy

Question 2

Risk factors for GDM

Answer 2

Genetic: age, ethnicity
Obs hx: prev LGA, GDM
Gynae: PCOS
PMHx: BMI++, IGT, CVD/htn/cholesterol, long term steroids
FHx: Diabetes (first degree)
SHx: inactivity/sedentary lifestyle

Question 3

Definition of gestational diabetes

Answer 3

Diabetes that develops during pregnancy and resolves with the birth of the baby

Question 4

Cx of GDM

Answer 4

Maternal: PET, HTN, infection, PTL, polyhydramnios, tears, PPH, T2DM

Foetal: macrosomia, stillbirth, congenital anomalies, RDS, long term metabolic cx

Question 5

Counsel for woman with T2DM who wishes to become pregnant

Answer 5

• A/w increased risk for both you and baby so important to plan
• Let GP know 3-6 months in advance
• Monitor BGL closely, start taking folic acid supplements
• Healthy lifestyle
• Specialist diabetes team referral
• Frequent BGL

Question 6

Timing and mode of birth GDM

Answer 6

• Vaginal preferable to c-section where no complications and glycaemic targets met