ENDOCRINOLOGY

Question 1

What are the risk factors for gestational diabetes

Answer 1

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)

Question 2

How do you diagnose diabetes in a pregnant woman ?

Answer 2

fasting glucose is >= 5.6 mmol/l

2-hour glucose is >= 7.8 mmol/l

Question 3

Management of pre-existing diabetes in pregnant women

Answer 3

1. weight loss for women with BMI of > 27 kg/m^2
2. stop oral hypoglycaemic agents, apart from metformin, and commence insulin
3. folic acid 5 mg/day from pre-conception to 12 weeks gestation
4. detailed anomaly scan at 20 weeks including four-chamber view of the heart and outflow tracts
5. tight glycaemic control reduces complication rates
6. treat retinopathy as can worsen during pregnancy