GDM Flashcards
define gestational diabetes
new onset insulin resistance with pregnancy that resolves after birth
2 most common complications of gestational diabetes for the neonate
macrosomia
neonatal hypoglycaemia
long term complication of gestational diabetes for the mother
raised risk of type 2 diabetes
who is screened for gestational diabetes and when? and how?
anybody with a risk factor
is given an OGTT
at 24-28 weeks gestation
risk factors for gestational diabetes (that warrant an OGTT at 24-28 weeks)
previous gestational diabetes
BMI >30
previous macrosomic baby (>4.5kg at birth)
Black, middle eastern, south Asian
first degree relative with gestational diabetes
other than risk factors for gestational diabetes, why else may a pregnant patient be offered an OGTT? (3)
large for gestational age baby
glucose on urine dip
polyhydramnios
what is the process of an OGTT?
fasting sugar is taken
patient is given a 75g glucose drink
blood sugar is taken 2 hours later
results indicating gestational diabetes:
fasting sugar
2 hours sugar
> 5.6mmol
> 7.8mmol
how is foetal growth and amniotic fluid volume measured for patients with gestational diabetes?
4 weekly USS from 28 weeks to 36 weeks
management of gestational diabetes:
fasting sugar <7
(3 options)
trial a diet and exercise regime for 1-2 weeks
then start metformin if this fails
then add insulin if this fails
management of gestational diabetes:
fasting sugar >7
start insulin and metformin
management of gestational diabetes:
fasting sugar >6 and macrosomia/other complications
start insulin and metformin
medical management of gestational diabetes for those who cannot tolerate metformin or decline insulin
glibenclamide (Sulfonylurea)
target glucose levels:
fasting
1 hour post meal
2 hours post meal
too low
<5.3
<7.8
<6.4
<4 is too low
true or false: patients with pre-existing diabetes need higher folate doses for the first 12 weeks of pregnan
rue - they need to take the 5mg folate
true or false: patients with pre-existing diabetes need higher folate doses for the first 12 weeks of pregnan
rue - they need to take the 5mg folate
how is type 2 diabetes managed in pregnancy?
insulin and metformin only
which complication of diabetes can rapidly progress in pregnancy?
retinopathy can rapidly progress in pregnancy - review by an ophthalmologist should be booked at booking and at 28 weeks
planned delivery for patients with pre-existing diabetes
planned delivery for patients with gestational diabetes
between 37 and 38+6/40
can deliver any time up to 40+6
how are blood sugars controlled during labour for patients with T1DM?
a sliding scale insulin regime may be used
can also be used for poorly controlled T2DM
how long will patients with gestational diabetes need to take their medications for after birth?
when will they need follow-up?
they can stop taking their medications immediately after birth
they will need to do a repeat OGTT at 6 weeks
consequences of birth and breastfeeding on pre-existing diabetes
increased insulin sensitivity i.e. patients should be wary of hypoglycaemia
5 neonatal issues arising from diabetes in the mother (other than macrosomia)
neonatal hypoglycaemia
neonatal jaundice
polycythaemia
congenital heart disease
cardiomyopathy
abnormally low blood sugar in a neonate is…
<2mmol
treatment of neonatal hypoglycaemia (2)
IV dextrose
nasogastric feeding
