GDM

Question 1

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

screening for GDM

Answer 2

previous GDM : booking - OGTT and at 24-28 w
any other RF’s - 24-28 w

Question 3

diagnostic thresholds for gestational diabetes

Answer 3

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

Question 4

mx of gestational diabetes

Answer 4

<7 : trial of diet and exercise - not met then metformin - still not met then insulin
>= 7 : insulin

Question 5

management of pre-existing diabetes in pregnancy

Answer 5

WL
stop oral hypoglycemics except metformin and start insulin
folic acid 5 mg / day
detailed anomaly scan 20 weeks

Question 6

complications of gestational diabetes

Answer 6

neonatal hypoglycaemia
macrosomia
Babies become accustomed to a large supply of glucose during the pregnancy, and after birth they struggle to maintain the supply they are used to with oral feeding alone.

Question 7

what screening should be performed

Answer 7

retinopathy screening

Question 8

glucose targets

Answer 8

Fasting: 5.3 mmol/l
1 hour post-meal: 7.8 mmol/l
2 hours post-meal: 6.4 mmol/l
Avoiding levels of 4 mmol/l or below

Question 9

cause of GDM

Answer 9

reduced insulin sensitivity during pregnancy - that resolves after birth