Gestational Diabetes

Question 1

What is gestational diabetes?

Answer 1

Onset of diabetes during pregnancy

Question 2

What are the risk factors for GSD?

Answer 2

BMI >30
Previous GSD
Previous macrosomic baby >4.5kg
1st degree relative with DM
South asian/middle eastern/afro-caribbean ethnicity

Question 3

What are the thresholds for diagnosis?

Answer 3

Fasting glucose >5.6

OGTT >7.8

Question 4

What is the screening program for GSD?

Answer 4

Previous GSD
-OGTT at booking and at 24-28wks

Any other risk factor
-OGTT at 24-28wks

Question 5

What is the management of GSD?

Answer 5

Refer to combined diabetes and antenatal clinic- consultant led care

If fasting glucose <7

• trial of diet and exercise
• if within a couple of weeks glucose is outside target range then add metformin
• still outside target range then add insulin (short acting)

If fasting glucose >7 or if 6-6.9 but evidence of complications (e.g. macrosomia)
-straight onto insulin

Question 6

What are the treatment targets?

Answer 6

Fasting <5.3
1hr post meal <7.8
2hrs post meal <6.4