Diabetes in pregnancy Flashcards
If a woman has preexisting type 1 or type 2 diabetes at the commencement of care, what is the responsibility of the midwife with regard to consultation and referral?
C refer
If a woman at the commencement of care presents with a history of gestational diabetes in a previous pregnancy, what is the responsibility of the midwife with regard to consultation and referral?
A discuss
If a woman develops gestational diabetes during pregnancy what is the responsibility of the midwife with regard to consultation and referral: if it is diet controlled? if she requires insulin?
if diet controlled - B consult
if requiring insulin - C refer
If a woman has a BMI 35 at the commencement of care, what is the responsibility of the midwife with regard to consultation and referral?
B consult
If a woman has a BMI >40 at the commencement of care, what is the responsibility of the midwife with regard to consultation and referral?
C refer
What is gestational diabetes?
any degree of glucose intolerance with onset or first recognition in pregnancy
What is the incidence of gestational diabetes?
GDM affects 8-10% of pregnancies in australia
When is GDM usually tested for?
routinely at 24-28 weeks gestation
early for high risk women at 12-16 weeks
at 6-8 weeks postpartum in women diagnosed with gestational diabetes
What are the risk factors for GDM?
- previous GDM
- previous stillbirth/FDIU
- ethnicity (indigenous australian, pacific islander, indian, SE Asian, middle eastern, maori, afro-carribean
- age > 40
- first degree relative with insulin dependent diabetes
- BMI>35
- previous macrosomia (>4500g)
- polycystic ovarian syndrome
- medications (corticosteroids, antipsychotics)
What 4 tests may be used in screening for GDM?
- oral glucose tolerance test (diagnostic)
- non fasting plasma glucose
- HbA1c (not reimbursed by medicare)
Criteria for diagnosis of GDM with a GTT
Fasting glucose >5.1 mmol/L
and/or
2h glucose >8 mmol/L
values vary according to local protocols
What is the procedure for a GTT?
- fasting for 10-12 hours
- baseline plasma glucose measured
- 75g glucose drunk within 5 mins
- plasma glucose measured at 1 hour and 2h
- no food, smoking, drinks other than water or exercise during test
What blood glucose levels should be targeted (fasting, 1 hour and 2 hour post meal) in diet controlled GDM?
- fasting
What strategies are common in managing GDM antenatally?
- modification of diet
- regular exercise
- home blood glucose monitoring
- increased frequency of antenatal visits
- interdisciplinary team (midwife, obstetrician, diabetes educator, dietition, other specialists)
- insulin
What are the associated risks of gestational diabetes?
- polyhydramnios
- preeclampsia
- C/S
- PPH
- perinatal death
- macrosomia (shoulder dystocia, perineal trauma)
- birth trauma
- neonatal hypoglycaemia, hypocalcaemia, magnesaemia
- respiratory distress syndrome
- hyperbilirubinaemia
- neonatal polycythaemia