GDM & Obesity Flashcards
Is HbA1c useful in GDM?
not a good indicator in pregnancy as less reliable due to physiological changes with blood volume/composition with pregnancy. It is typically lower in pregnancy and the timing and frequency of when it should be performed is unclear
What is the screening for GDM?
OGTT at 28W
If elevated baseline fasting, 1hr or 2hr post-glucose load then diagnosed with diabetes (only need one elevated)
Fasting >=5.1
1hr >10
2hr >8.5
What is the monitoring for GDM?
4x BGL daily
- Morning + after each 3 meals
HbA1c not a good indicator
Aim for 4.0 - 5.5 fasting or =< 7 if post-prandiol
What are the risk factors for GDM?
Overweight/Obesity Previous GDM FHx GDM or diabetes Maternal age >30 ATSI and asian ethnicity PCOS Previous large baby
50% have NO risk factors - why screening is important
What are the maternal/pregnancy/foetal risks of GDM?
Increased risk of developing T2DM - need to test 6-12 weeks post-partum and have OGTT screening every 2-3 years Increased risk of subsequent GDM Infections Pre-eclampsia PPH
Miscarriage, stillbirth/IUFD
Increased risk of premature birth, instrumental delivery
If insulin required - increased risk of IUGR
What are the neonatal risks of GDM?
Metabolic - hypoglycaemia, low Mg and Ca at birth
Polycythaemia
Hyperbilirubinaemia
Respiratory distress - related to prematurity, surfactant issues and wet lung
What are the long-term risks to infant of GDM?
Increased risk of overweight/obesity
Increased risk of diabetes
What is the antenatal management of GDM?
Multi-disciplanary management - DNE, paediatrician, endocrinologist, dietician
More frequent antenatal visits and monitoring for risks
- Monthly urinalysis and regular BP
- Weekly CTG and biophysical profile from 36W and 3rd trimester growth scan
Diet and weight advice and management to control levels
BGL monitoring
Timing of delivery
- Aim for >37 and don’t allow post-term
- NVD ideal unless issues
10-20% will require insulin
What is the intrapartum management of GDM?
Hartman’s solution during labour if on insulin
Continuous CTG monitoring
Regular BGL monitoring to avoid hypoglycaemia or hyperglycaemia
If elective C-section, ensure morning list
Insulin requirements rapidly fall during labour and after birth
What is post-partum management of GDM?
Mother and baby increased risk of hypo - monitor and allow to run slightly high, early breastfeeding for baby
If risk factors admit to special care nursery
If diabetes pre-pregnancy what are additional management considerations?
Recommend planned pregnancy with pre-natal assessment
- Should assess weight, micro and macrovascular risk factors including blood lipids, podiatry and opthalmology reivew as pregnancy can exacerbate complications
Increased risk of hypos and decreased awareness of them so education and close monitoring
If insulin requirements fall this is a red flag for IUGR
During labour need to have hartman’s solution and close monitoring but want to especially avoid hypo as insulin requirements fall during this time
What are the risks to mother/pregnancy with obesity?
Increased risk of GDM, pre-eclampsia and mortality
More likely to be post-dates, need for induction, instruments or operative delivery
More likely to have increased LOS and antibiotics after delivery
Increased risks with epidural proceedure - dosage issues and risk of high block
Clinical monitoring and U/S more difficult
Fertility issues - irregular ovulation
Breast-feeding issues more common - late and decreased supply
What are the neonatal risks if obese mother?
Macrosomia or IUGR
Increased risk of NICU admission
Perinatal/still birth
NTD and congenital abnormalities
Long-term - epigenetics - increased risk of obseity, CVD/metabolic syndrome
