Diabetes in Pregnancy

Question 1

What is the generalised definition of Gestational Diabetes?

Answer 1

Any degree of insulin resistance/ glucose intolerance with first onset or first recognition in pregnancy.

Question 2

What are the RF Gestational Diabetes

Answer 2

Genetic

• Family Hx
• Previous Gestational Diabetes.
• Black and Asian populations.

Inflammatory state

• Smoking
• Sedentery lifestyle, poor diet.
• Hypercholesterolemia, obesity.

Hormonal dysregulation:

• PCOS
• Obesity
• Age

Question 3

At what stages of pregnancy are women tested for gestational diabetes?

What is the common tests used at each time?

What results are indicative of Gestational Diabetes?

Answer 3

If presence of risk factors: Test done at first antenatal visit.

If no risk factors: test done at 24-28 weeks.

Test: OGTT.

Diagnosed with GDM if ANY of the following values are met or exceeded:

A. 75g OGTT

Fasting-5.1 mmol; 1hr-10.0 mmol; 2 hr-8.5 mmol.

B.

1. 50g OGTT - If after 1 hour >/= 7.8mmol go to step 2.
2. 100g OGTT

Fasting-5.3mmol; 1hr-10.0mmol; 2hr-8.6mmol; 3hr-_7.8mmol_

Question 4

What are the clinical features of Gestational Diabetes?

Answer 4

• usually asymptomatic.
• polyurea
• polydipsia (excessive thirst)
• UTIs
• vulvovaginal candidiasis (uncommon)

NOT SYSTEMIC SYMPTOMS!! NOT ENOUGH TIME FOR IT TO DEVELOP

Question 5

What are the potential complications of GDM?

Answer 5

1. Fetal M+M

Antenatal: macrosomia, IUGR, Fetal malformations, miscarriage.

Perinatal: brachial plexus injuries, shoulder dystocia, C-Section (common).

Postnatal: neonatal hypoglycemia, jaundice (neonatal polycythemia).

Later: increased likelihood of getting DM.

2. Maternal M=M

Antenatal: HTN, pre-eclampsia.

Perinatal: Pre-term labour (common)

Postnatal: post-pregnancy DM (7% risk).

Detection: can decrease all of the above risks.

• Antenatal glycemic control.
• Lifestyle modification to prevent Post-Natal DM development.

Question 6

What is the management of GDM?

Answer 6

1. Diet and exercise control

2a. Home glucose monitoring

Recommended Frequency of Testing

Four times per day (fasting and 1 or 2-hrs after each meal depending on OGTT result)

At least three days of the week.

AIM: • Fasting <5.1mmol/L • 1H <7.4 mmol/L • 2H < 6.7 mmol/L

2b. Insulin injections for symptomatic hyperglycemia

Sub-optimal Blood Glucose levels - If levels are above the recommended goals (above) on 2 or more occasions in a day, or two readings for a particular meal time within a week.

3. Post partum FU:

• OGTT 6-8 weeks post partum.
• OGTT 12 weeks with next pregnancy and (if normal) 28 weeks.