Gestational Diabetes

Question 1

what is gestational diabetes?

Answer 1

diabetes triggered by pregnancy
caused by reduced insulin sensitivity during pregnancy
resolves after birth

Question 2

2 main complications of gestational diabetes?

Answer 2

large for dates/macrosomnia (and risk of shoulder dystocia etc that comes along with it)
type 2 diabetes following pregnancy

Question 3

how are women at risk of gestational diabetes screened?

Answer 3

oral glucose tolerance test at 24-28 weeks

Question 4

risk factors for gestational diabetes?

Answer 4

previous gestational diabetes
previous macrosomic baby
BMI >30
ethnic origin (afro-Caribbean, middle eastern, south Asian)
family history of diabetes (1st degree relative)

Question 5

screening test of choice in gestational diabetes?

Answer 5

OGTT

used in high risk people and in pregnant women with features suggesting gestational diabetes

Question 6

what features in pregnancy might suggest gestational diabetes?

Answer 6

large for dates foetus
polyhydramnios
glucose on urine dip

Question 7

how is an OGTT done?

Answer 7

fasted overnight
blood glucose measured
patient then drinks 75g glucose drink
blood glucose measures 2 hrs after glucose drink

Question 8

normal OGTT results?

Answer 8

fasting = <5.6 mmol/L

2 hrs = <7.8mmol/L

Question 9

how is OGTT used to diagnose gestational diabetes?

Answer 9

either one of:
- fasting glucose >5.6
- 2 hr glucose >7.8
can diagnose gestational diabetes (dont need both)

Question 10

how are pregnant women with gestational diabetes monitored?

Answer 10

growth scans every 4 weeks from 28-36 weeks

Question 11

initial management of gestational diabetes if fasting glucose <7?

Answer 11

trial diet and exercise for 1-2 weeks

followed by metformin, then insulin

Question 12

initial management of gestational diabetes if fasting glucose >7?

Answer 12

start insulin +/- metformin

Question 13

initial management of gestational diabetes if fasting glucose >6 but there is foetal macrosomnia (or any other complication) present?

Answer 13

start insulin +/- metformin

Question 14

what drugs might be used is women declines insulin or cannot tolerate metformin?

Answer 14

glibenclamide (type of sulphonylurea)

Question 15

target blood glucose levels in gestational diabetes?

Answer 15

fasting = 5.3
1hr post meal = 7.8
2 hrs post meal = 6.4
should avoid levels of 4 or below

Question 16

women with pre-existing diabetes should be taking what before pregnancy?

Answer 16

5mg folic acid from preconception up until 12 weeks gestation

Question 17

target insulin levels in type 1/2 diabetes?

Answer 17

same as gestational diabetes

Question 18

how is type 2 diabetes managed in pregnancy?

Answer 18

metformin and insulin (other oral diabetes meds should be stopped)

Question 19

what extra screening is done in pregnant women with pre-existing diabetes?

Answer 19

retinopathy screening shortly after booking and again at 28 weeks gestation

Question 20

when is baby delivered in pre-existing diabetes?

Answer 20

planned delivery between 37 and 38+6 weeks

Question 21

when is baby delivered in gestational diabetes?

Answer 21

can give birth up to 40+6 weeks

Question 22

how is pre-existing type 1 diabetes managed during labour?

Answer 22

sliding scale insulin regime

dextrose and insulin infusion is titrated to blood sugar levels according to local protocols

Question 23

when else is a sliding scale insulin regime used?

Answer 23

poorly controlled type 2 or gestational diabetes during labour

Question 24

how long does gestational diabetes take to resolve after birth?

Answer 24

resolves immediately and can stop meds immediately after birth

Question 25

gestational diabetes follow up after birth?

Answer 25

fasting glucose tested 6 weeks after birth

Question 26

pre-existing diabetes after birth?

Answer 26

women should lower their insulin doses and be aware of hypoglycaemia risk
insulin sensitivity will increase after birth and while breastfeeding

Question 27

babies born to diabetic mothers are at risk of what?

Answer 27

neonatal hypoglycaemia
polycythaemia (raised haemoglobin)
jaundice
congenital heart disease
cardiomyopathy
shoulder dystocia

Question 28

how are babies born to diabetic mother monitored after birth?

Answer 28

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