Gestational diabetes

Question 1

At what weight is scheduled c-section offered to women with GDM?

Answer 1

estimated weight > 4500 gm

Question 2

When should women with GDM be delivered? Diet controlled GDM vs Med controlled GDM?

Answer 2

Diet control: reasonable to wait until 40/41 weeks, get a fetal ultrasound at weeks 37-38 for fetal size assessment and counseling

Medication control: Patients with well-controlled gestational diabetes treated with oral medications or insulin are recommended to undergo induction of labor between 39 0/7-39 6/7 weeks

Question 3

What are target glucose levels for GDM prenatally?

Answer 3

Fasting 70-90 mg/dl
140 mg/dl at one hour post prandial
120 mg/dl at 2 hours post prandial

Question 4

What % of glucose readings in GDM need to be within range to be considered good control?

Answer 4

The target level control is 80% of glucose values within appropriate range. This assessment hinges on the acquisition of a reasonable number of BG values per day.
Additionally, written diary of BG should be validated against the patient’s glucometer.

Question 5

How is GDM treated prenatally if not diet controlled?

Answer 5

• If BG are elevated both fasting and post meal, start metformin 500mg twice daily withbreakfast and dinner.
• If fasting BG are in target range, then once daily dosing with breakfast may be. adequate.
• All women should be counseled that some mild GI upset is common in the first days of metformin use and that the majority of cases improve and/or resolve.

Question 6

How do you titrate metformin for GDM?

Answer 6

If BG control is inadequate, the dose may be increased by increments of 500mg in either daily or twice daily dosing as the glycemic profile dictates up to a maximum of maximum of 2,550 mg/day

Question 7

How often and WHEN do you need to do ATU testing for GDM patients?

Answer 7

Patients with gestational diabetes requiring medical treatment or without documented good glucose control with diet will begin a regimen of twice weekly
antenatal testing starting at 32 weeks.

For good DIET control, can start at 36 weeks

Question 8

What are reasons for early screening of GDM in first trimester? Up to 9 reasons.

Answer 8

 Personal history of GDM
 Obesity (BMI≥30)
 PCOS
 Impaired glucose tolerance
 Glycosuria early in pregnancy
 Strong family history of diabetes (one first degree relative, or more than one second degree relative)
 Previous macrosomic infant.
 Previous unexplained third trimester loss or neonatal death.
 Chronic hypertension

Question 9

What are the glucose levels goals during intrapartum?

Answer 9

In absence of clear goals, a reasonable target range for intrapartum glucose levels is >70 and <126 mg/dL (>3.9 and <7.0 mmol/L), as a similar range has not been associated with clinically important neonatal hypoglycemia in insulin-requiring women

Question 10

How often to check glucose levels intrapartum?

Answer 10

Diet control: every 4-6 hours
Med control or suboptimal control: every two to four hours during the latent phase, every one to two hours during the active phase, and every hour when insulin is being infused.

Question 11

How to manage a GDM patient re: their insulin prior to c-section or induction?

Answer 11

Before scheduled early morning induction or cesarean delivery, the patient should maintain her usual nighttime dose of intermediate-acting insulin, short- or rapid-acting insulin, oral antihyperglycemic medication, or continuous insulin infusion. Women controlled on long-acting basal insulin should take 50 percent of their nighttime dose