DISEASE- gestational diabetes Flashcards
What is the 2nd most common disease from pregnancy complications?
gestational diabetes
What is gestational diabetes?
Diabetes that develops in pregnancy and usually goes away after birth
what causes gestational diabetes?
Gestational diabetes is a state of insulin resistance induced by the metabolic strain of pregnancy (due to the HPL + cortisol)
when is gestational diabetes most often picked up?
third trimester of pregnancy (24-28 weeks)
when are the risks for gestational diabetes determined?
at booking appointment
what are the risks of gestational diabetes and what should be done if any are present?
RISKS:
-Previous history of gestational diabetes
-Previous history of macrosomic baby weighing 4.5Kg or above
-BMI >30
-First degree relative with diabetes
-South Asian, Black Carribbean and Middle Easter origin (high prevalence of diabetes)
Any of these risks warrant OGTT
what features during pregnancy may suggest gestational diabetes?
-Polyhydramnios
-Large for date fetus
-Glucose on urine dipstick
first line screening for gestational diabetes?
OGTT
what are the cut offs for OGTT?
fasting glucose >=5.6
2 hour glucose >=7.8
Glycaemic targets- gestational diabetes?
measure blood glucose 4x daily:
-fasting (pre breakfast)
-postmeals (1 hour or 2 hours post meal)
-before bed
Fasting 5.5mmol/l
1hr <7.8mmol/l
2hr <6.4mmol/l
Treatment- gestational diabetes?
a low GI diet + exercise
plus metformin (fasting glucose 5.6- 6.9) and insulin if required (fasting glucose >=7)
Decline in insulin/ can’t tolerate metformin= Glibenclamide
Women with gestational diabetes should give birth no later than 40+6 weeks of gestation
women with gestational diabetes should give birth no later than what date?
40 + 6 weeks
At what estimated fetal weight should a woman with gestational diabetes be offered a C section
> 4.5kg
Common complications of gestational diabetes?
-Pre eclampsia
-Polyhydramnios
-Macrosomnia
-Shoulder dystocia
-Neonatal hypoglycaemia
