GDM Flashcards
GDM Test for:
- Women with Rx
- Women with previous GDM
- 2hr 75mg OGTT test at 24-28 weeks (26/40 normally)
- early self monitoring
OR
2hr 75mg OGTT test asap after booking (IF -VE REPEAT at 24-26 weeks)
Diagnosis GDM mmol/L?
a fasting plasma glucose of 5.6mmol/l or above
OR
a 2hr plasma glucose level of 7.8mmol/l or above
Information and advise to GDM women?
- Implications for her and her baby (short and long term)
- > Macrosomia (shoulder dystocia), polyhydramnios, still- birth, C-sec or instrumental delivery, premature birth, pre-eclam, neonatal hypoglycaemia
- changes in diet and exercise
- > replace high GI index foods for low GI index foods
- > encourage exercise- 30 minutes walk after food
- > refer to dietitian
Treatment?
(Remember diagnosis if fasting plasma glucose above 5.6 and 2 hour plasma glucose above 7.8)
If under 7mmol/L at diagnosis: offer 1 week trail of diet and exercise control -> Unsuccessful= metformin (if metformin contraindicated give insulin) -> Still unsuccessful and blood glucose target not met add insulin
LADDER for under 7 at diagnosis: Diet/Exercise -> + metformin -> + insulin
If above 7 mmol/L at diagnosis: IMMEDIATE INSULIN and changes in diet and exercise (+/- metformin)
If between 6 - 6.9mmol/L & complications (such as macrosomina or hydramnios) = IMMEDIATE INSULIN and changes in diet and exercise (+/- metformin)
Timetable of antenatal appointments for diabetes during pregnancy?
- Booking appointment
- 16 weeks
Booking appointment:
- Discuss information, education and advice about how diabetes will affect the pregnancy, birth and early parenting (such as breastfeeding and initial care of the baby).
- review medicines for diabetes and its complications.
- Offer retinal assessment and renal assessment for women with pre‑existing diabetes unless the woman has been assessed in the last 3 months.
- Arrange contact with the joint diabetes and antenatal clinic every 1–2 weeks throughout pregnancy for all women with diabetes.
- Measure HbA1c levels for women with PRE-EXISTING diabetes to determine the level of risk for the pregnancy.
- Offer self‑monitoring of blood glucose or a 75 g 2‑hour OGTT as soon as possible for women with a history of gestational diabetes who book in the first trimester.
16 weeks:
- Offer self‑monitoring of blood glucose or a 75 g 2‑hour OGTT as soon as possible for women with a history of gestational diabetes who book in the second trimester.
20 weeks:
- Offer an ultrasound scan for detecting fetal structural abnormalities, including examination of the fetal heart
28 weeks:
- Offer ultrasound monitoring of fetal growth and amniotic fluid volume.
- Offer retinal assessment to all women with pre‑existing diabetes.
- Women diagnosed with gestational diabetes as a result of routine antenatal testing at 24–28 weeks enter the care pathway.
34 weeks- same as other women (normal appointment)
36 weeks:
- Offer ultrasound monitoring of fetal growth and amniotic fluid volume.
- Provide information and advice about:
- > timing, mode and management of birth
- > analgesia and anaesthesia
- > changes to blood glucose‑lowering therapy during and after birth
- > care of the baby after birth
- > initiation of breastfeeding and the effect of breastfeeding on blood glucose control
- > contraception and follow‑up.
37+0 to 38+6
- Offer induction of labour, or caesarean section if indicated, to women with type 1 or type 2 diabetes; otherwise await spontaneous labour.
38 weeks: test fetal wellbeing
39 weeks: test fetal wellbeing
Advise women with uncomplicated gestational diabetes to give birth no later than 40+6 weeks.
GDM timing of delivery?
- T1DM or T2DM & no complications
- GDM
- Induced or C-sec between 37+0 weeks and 38+6 weeks
- GDM
- controlled via diet: induce at 40
- with medication: ??
Postnatal care for GDM?
- Life style advise
- Check fasting plasma glucose at 6-13 weeks (probs 6 week check ) to exclude ongoing diabetes
Offer an annual HbA1c test to women who were diagnosed with gestational diabetes who have a negative postnatal test for diabetes.
Rx for GDM (5)
- Ethnicity
- Previous GDM
- Macrosomia (>4.5 kg)
- FHx
- BMI >30
