GDM Flashcards
diagnostic criteria for GDM from OGTT
diagnosis is made if one or more of the following values are abnormal
venous plasma glucose level of:
likely overt diabetes
women with markedly elevated glucose levels during pregnancy:
fasting > 7
random > 11.1
or an HbA1c >6.5%
can be classified as having likely overt diabetes
these women may have pre-existing diabetes and should be screened for diabetes complications
a definitive diagnosis of non-gestational diabetes cannot be made until the post-partum period
high risk factors for GDM
previous GDM
ethnicity: asain (including Indian), aboriginal, pacific islander, maori, middle eastern, non-white african
maternal age >40
family Hx of DM
obesity
hypertension prior to 20 weeks
previous macrosomia (baby with birth weight > 4000g)
Hx unexplained stillbirth
previous baby with congenital abnormalities
PCOS
medications: corticosteroids, antipsychotics
routine testing for GDM
all women not previously diagnosed with diabetes are recommended to have a standard 75g OGTT between 24-28 weeks gestation
early screening for GDM for women at high risk
a standard 75g OGTT either before or at the first opportunity after conception
diabetes and pregnancy service
referrals can be made to diabetes and pregnancy clinics or diabetes educators
involve multidisciplinary approach for antenatal care, blood glucose meters, insulin, continuous glucose monitoring, insulin pumps, NDSS (national diabetes services scheme)
principles of management of GDM
- refer to diabetes education and diabetes service education classes
- refer to ddietitian
- BGL aims to reduce rate of fetal anomalies, macrosomia, maternal hypo/hyperglycaemia, neonatal hypoglycaemia
- exercise
- fetal surveillance
- maternal surveillence for opthalmology, thyroid, renal damage, vasculopathy, insulin requirement
- consider elective c/s if macrosomia is likely
- arrange eleective birth at 38-39 weeks for women requiring insulin
