gestational diabetes Flashcards
gestational diabetes
diabetes triggered by pregnancy
caused by reduced insulin sensitivity during pregnancy and resolves after birth
significant complication
macrosomia which is risk for shoulder dystocia
screening
anyone with risk factors should have OGTT at 24-28wks
risk factors
prev GDM prev macrosomic baby BMI >30 ethnic - black carribean, middle eastern, south asian FHx diabetes
who has OGTT
patient with risk factors
pt with features suggestive of GDM
features that suggest gestational diabetes
large for dates fetus
polyhydramnios
glycosuria
how is OGTT done
performed in morning after a fast
pt drinks 75g Glc drink
BG measured before drink and 2 hours after
OGTT - normal results
fasting < 5.6
2 hrs < 7.8
OGTT - result of GDM
fasting > 5.6
2 hrs > 7.8
Mx - fasting Glc <7
trial of diet + exercise up to 2wks
metformin then inuslin
Mx - fasting Glc >7
start insulin +/- metformin
Mx - fasting Glc >6 and macrosomia
start insulin +/- metformin
Mx - option for women who decline insulin/can’t tolerate metformin
glibenclamide (a sulfonylurea)
target levels: fasting
5.3
target levels: 1 hr post meal
7.8
target levels: 2hrs post meal
6.4
pre-existing diabetes: before conception
aim for good glucose control
5mg folic acid
pre-existing diabetes: Mx T2DM
metformin and insulin
other oral diabetic medications should be stopped
retinopathy screening when
booking
28wks
pre-existing diabetes: planned delivery
37 - 38+6
pre-existing diabetes:T1DM in labour
sliding insulin scale regime
insulin and dextrose infusion titrated to BG levels
postnatal care
GMD - can stop taking diabetic medications
pre-existing DM - lower insulin doses and be wary of hypos
babies of mothers with diabetes are at risk of
neonatal hypoglycaemia polycythemia jaundice congenital heart disease cardiomyopathy
