Gestational Diabetes Flashcards
what is gestational diabetes?
diabetes triggered by pregnancy
caused by reduced insulin sensitivity during pregnancy
resolves after birth
2 main complications of gestational diabetes?
large for dates/macrosomnia (and risk of shoulder dystocia etc that comes along with it)
type 2 diabetes following pregnancy
how are women at risk of gestational diabetes screened?
oral glucose tolerance test at 24-28 weeks
risk factors for gestational diabetes?
previous gestational diabetes
previous macrosomic baby
BMI >30
ethnic origin (afro-Caribbean, middle eastern, south Asian)
family history of diabetes (1st degree relative)
screening test of choice in gestational diabetes?
OGTT
used in high risk people and in pregnant women with features suggesting gestational diabetes
what features in pregnancy might suggest gestational diabetes?
large for dates foetus
polyhydramnios
glucose on urine dip
how is an OGTT done?
fasted overnight
blood glucose measured
patient then drinks 75g glucose drink
blood glucose measures 2 hrs after glucose drink
normal OGTT results?
fasting = <5.6 mmol/L
2 hrs = <7.8mmol/L
how is OGTT used to diagnose gestational diabetes?
either one of:
- fasting glucose >5.6
- 2 hr glucose >7.8
can diagnose gestational diabetes (dont need both)
how are pregnant women with gestational diabetes monitored?
growth scans every 4 weeks from 28-36 weeks
initial management of gestational diabetes if fasting glucose <7?
trial diet and exercise for 1-2 weeks
followed by metformin, then insulin
initial management of gestational diabetes if fasting glucose >7?
start insulin +/- metformin
initial management of gestational diabetes if fasting glucose >6 but there is foetal macrosomnia (or any other complication) present?
start insulin +/- metformin
what drugs might be used is women declines insulin or cannot tolerate metformin?
glibenclamide (type of sulphonylurea)
target blood glucose levels in gestational diabetes?
fasting = 5.3
1hr post meal = 7.8
2 hrs post meal = 6.4
should avoid levels of 4 or below
women with pre-existing diabetes should be taking what before pregnancy?
5mg folic acid from preconception up until 12 weeks gestation
target insulin levels in type 1/2 diabetes?
same as gestational diabetes
how is type 2 diabetes managed in pregnancy?
metformin and insulin (other oral diabetes meds should be stopped)
what extra screening is done in pregnant women with pre-existing diabetes?
retinopathy screening shortly after booking and again at 28 weeks gestation
when is baby delivered in pre-existing diabetes?
planned delivery between 37 and 38+6 weeks
when is baby delivered in gestational diabetes?
can give birth up to 40+6 weeks
how is pre-existing type 1 diabetes managed during labour?
sliding scale insulin regime
dextrose and insulin infusion is titrated to blood sugar levels according to local protocols
when else is a sliding scale insulin regime used?
poorly controlled type 2 or gestational diabetes during labour
how long does gestational diabetes take to resolve after birth?
resolves immediately and can stop meds immediately after birth
gestational diabetes follow up after birth?
fasting glucose tested 6 weeks after birth
pre-existing diabetes after birth?
women should lower their insulin doses and be aware of hypoglycaemia risk
insulin sensitivity will increase after birth and while breastfeeding
babies born to diabetic mothers are at risk of what?
neonatal hypoglycaemia polycythaemia (raised haemoglobin) jaundice congenital heart disease cardiomyopathy shoulder dystocia
how are babies born to diabetic mother monitored after birth?
regular blood glucose checks
frequent feeds
aim to maintain blood sugar above 2mmol
may need IV dextrose or NG feeding if it falls below 2
