diabetes in pregnancy

Question 1

when in pregnancy do women have the OGTT?

Answer 1

Oral glucose tolerance test in women at risk of gestational diabetes (between 24 – 28 weeks)

Question 2

what are the limits on the GTT?

Answer 2

• Fasting glucose is >= 5.6 mmol/L, or
• 2-hour glucose level of >= 7.8 mmol/L
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Question 3

what is target fasting glucose?

Answer 3

5.3 mmol/l

Question 4

what is target glucose 1 hr after meals?

Answer 4

7.8 mmol/l

Question 5

what is target glucose 2 hrs after meals?

Answer 5

6.4 mmol/l

Question 6

what gestational age is the GTT usually done?

Answer 6

24-28 weeks

Question 7

what are risk factors for gestational diabetes?

Answer 7

• BMI of > 30 kg/m²
• previous macrosomic baby weighing 4.5 kg or above
• previous gestational diabetes
• first-degree relative with diabetes
• family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)

Question 8

what is first line management for women with gestational diabetes?

Answer 8

• should be seen in diabetes antenatal clinic within a week
• Monitor their glucose
• try diet and exercise if fasting glucose is <7 mmol/l
• if >7 at the time of diagnosis then insulin should be started
• if 6-6.9mmol/l- insulin should be offered

Question 9

how long should diet and exercise be trailed before starting metformin?

Answer 9

1-2 weeks, if it doesn’t work start metformin

Question 10

what is the next step if glucose levels are still not met with diet, exercise and metformin?

Answer 10

• long and short acting insulin

- if woman refuses can step up the metformin to glibenclamide

Question 11

what management should be implemented for pre-existing diabetics?

Answer 11

• weight loss for women with BMI of > 27 kg/m^2
• stop oral hypoglycaemic agents, apart from metformin, and commence insulin
• folic acid 5 mg/day from pre-conception to 12 weeks gestation
• detailed anomaly scan at 20 weeks including four-chamber view of the heart and outflow tracts
• tight glycaemic control reduces complication rates
• treat retinopathy as can worsen during pregnancy
• planned delivery at 37- 38 weeks

Question 12

when can gestational diabetics give birth to?

Answer 12

40 + 6

Question 13

what should gestational diabetics do about their medication after they have given birth?

Answer 13

• they can stop it

- they willed follow up in at least 6 weeks to check their glucose levels

Question 14

what are the 2 main complications of gestational diabetes for the baby?

Answer 14

1. macrosomia
2. neonatal hypoglycaemia- since they were used to a high level of glucose in utero so they struggle to meet that supply with oral feeding alone

Question 15

how should you manage baby you suspect may have neonatal hypoglycaemia?

Answer 15

• regular blood glucose checks
• frequent feeds
• aim to keep blood glucose >2mmol/l
• if it falls givenr IV dextrose or may need NG feeding

Question 16

when do women with previous gestational diabetes have their OGTT?

Answer 16

soon after booking clinic

Question 17

what are the risks to the mother of having gestational diabtetes?

Answer 17

• increased risk of pre-eclampsia
• polyhydramnios
• developing T2DM

Question 18

what are all the risks to the baby of gestational diabetes?

Answer 18

• macrosomia= shoulder dystocia and increased risk of birthing trauma to mother, can also cause trauma to foetus such as brachial plexus injury, facial palsy, cervical or humerus fracture, cephalotoma, subdural haematoma
• impaired lung development= because there is less surfactant due to high insulin
• hypoglycaemia= because get increased insulin inutero but get loss of sugary environment
• hyperbilirubinaemia= increased fetal metabolic rate due to increased consumption of glucose and oxygen can cause fetal hyperaemia and metabolic acidosis, this stimulates erythropoiesis and can lead to polycytheamia- RBC breakdown can leas to hyperbilirubbinaemia

still birth= often a cardiomyopathy complained with complications of shoulder dystocia can lead to perinatal asphyxia and death

babies will have an increased risk of obesity later in life

Question 19

what prophylactic antenatal care should people with pre-existing diabetes get?

Answer 19

• 5mg of folate in the first trimester

- aspirin 150mg to reduce the risk of pre-eclampsia

Question 20

how often should diabetics have gowth scans?

Answer 20

every 2-4 weeks

Question 21

when should diabetics have the fetal echo?

Answer 21

18 weeks

Question 22

what will the GP check at 6-12 weeks post pregnancy in someone with gestational diabetes?

Answer 22

HBA1C

Question 23

Which diabetic medication is deffo not suitable to give to breast-feeding mothers?

Answer 23

gliclazide

Question 24

what fasting glucose requires insulin to be started straight away?

Answer 24

When fasting glucose is >7 mmol/L at the diagnosis of gestational diabetes insulin should be started immediately