Diabetes in Pregnancy

Question 1

Who should be screened for gestational diabetes?

Answer 1

Anyone with following risk factors:

• BMI >30
• Previous macrosomic baby
• Previous GDM
• 1st degree relative with DM
• Family origin (South Asian, Caribbean, Middle Eastern)
• Urinalysis +ve glucose

Question 2

How do you screen for GDM?

Answer 2

Glucose tolerance test offered between 24-28 weeks.

Question 3

What is criteria for GDM?

Answer 3

> 5.6 fasting

>7.8 2 hour post

Question 4

What is management of GDM?

Answer 4

1) Offer home glucose monitor, encourage to check BM for at least 2 days
2) Simple lifestyle advice; adjust diet and be more active
3) If cannot control, add metformin
4) If still cannot control, or fasting >7 start insulin

Question 5

What extra care is required for GDM antenatally and postnatally?

Answer 5

Growth scans to check for macrosomia
Consider whether vaginal delivery is appropriate (risk of shoulder dystocia)
Do not deliver later than 40+6
Check baby BM post-delivery 2-4 hourly
6 week post-natal fasting glucose for mother

Question 6

When should a HbA1c be performed antenatally?

Answer 6

Check HbA1c at diagnosis of GDM to exclude pre-existing DM. However, after this it should not be used for monitoring.

Question 7

What is the follow-up for patients with GDM?

Answer 7

6 week post-natal fasting BM.

<6.0: Moderate risk of developing T2DM, for annual HbA1c.

6.0-6.9: High risk developing T2DM, offer intervention.

> 7.0: Likely to have T2DM, for HbA1c.