Diabetes in pregnancy Flashcards
What are the risk factors for gestational diabetes
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)
How to identify gestational diabetes
the oral glucose tolerance test (OGTT)
Who should be offered the OGTT
women who’ve previously had gestational diabetes: OGTT should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.
women with any of the other risk factors should be offered an OGTT at 24-28 weeks
what is the diagnostic threshold for fasting glucose
fasting glucose is >= 5.6 mmol/L
what is the diagnostic threshold for 2 hour glucose
2-hour glucose is >= 7.8 mmol/L
What should be done with newly diagnosed women
should be seen in a joint diabetes and antenatal clinic within a week
women should be taught about self-monitoring of blood glucose
advice about diet (including eating foods with a low glycaemic index) and exercise should be given
What should be done if fasting plasma glucose level is < 7 mmol/l
trial of diet and exercise should be offered
f glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started
What should be added if fasting plasma glucose level is < 7 mmol/l and the targets are not met after metformin is introduced
add short-acting, not long-acting, insulin
What to do if fasting glucose level is >= 7 mmol/l
insulin should be started
What to do if the plasma glucose level is between 6-6.9 mmol/l, and there is evidence of complications such as macrosomia or hydramnios
Offer insulin
Who do we offer glibenclamide to
glibenclamide should only be offered for women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment
How to manage pregnant women with pre existing diabetes
weight loss for women with BMI of > 27 kg/m^2
stop oral hypoglycaemic agents, apart from metformin, and commence insulin
folic acid
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
How much folic acid to be given
5 mg/day from pre-conception to 12 weeks gestation
What is the fasting targets for self monitoring of pregnant women (pre-existing and gestational diabetes)
5.3 mmol/l
What is the 1 hour after meal target for self monitoring of pregnant women (pre-existing and gestational diabetes)
7.8 mmol/l
