Gestational Diabetes

Question 1

Gestational Diabetes

Answer 1

Diabetes triggered by pregnancy

Question 2

Pathophysiology of gestational diabetes

Answer 2

Caused by reduced insulin sensitivity during pregnancy, and resolves after birth

Question 3

Complications of gestational diabetes

Answer 3

Macrosomia - shoulder dystocia and Erbs palsy

Higher risk of T2DM after pregnancy

Question 4

Screening for gestational diabetes

Answer 4

Oral glucose tolerance test at 24 – 28 weeks gestation.

Women with previous gestational diabetes also have an OGTT soon after the booking clinic

Question 5

Risk factors for gestational diabetes

Answer 5

Previous gestational diabetes

Previous macrosomic baby (≥ 4.5kg)

BMI > 30

Ethnic origin (black Caribbean, Middle Eastern and South Asian)

Family history of diabetes (first-degree relative)

Question 6

Features that suggest gestational diabetes:

Answer 6

• Large for dates fetus
• Polyhydramnios (increased amniotic fluid)
• Glucose on urine dipstick

Question 7

OGTT results

Answer 7

Gestational diabetes if :

Fasting: > 5.6 mmol/l
At 2 hours: > 7.8 mmol/l

Question 8

Management of gestational diabetes

Answer 8

Joint diabetes and antenatal clinic
Dietician input

4 weekly USS scans for monitoring from 28 - 26 weeks

Fasting glucose < 7 mmol/l: trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin

Fasting glucose above 7 mmol/l: start insulin ± metformin

Fasting glucose above 6 mmol/l plus macrosomia (or other complications): start insulin ± metformin

Question 9

Target blood sugar levels of women who have gestational diabetes

Answer 9

Fasting: 5.3 mmol/l
1 hour post-meal: 7.8 mmol/l
2 hours post-meal: 6.4 mmol/l
Avoiding levels of 4 mmol/l or below

Question 10

Pre-Existing Diabetic woman planning pregnancy

Answer 10

Tight blood sugar control

5mg folic acid from preconception till 12 weeks (higher dose)

Use insulin and metformin - other diabetes medication should be stopped

Retinopathy screening

Question 11

When should pre - existing diabetics give birth

Answer 11

Advise planned delivery between 37 and 38 + 6 weeks

Question 12

When can gestational diabetics give birth

Answer 12

Can give birth up to 40 + 6

Question 13

T1DM during labour

Answer 13

A sliding-scale insulin regime is considered

Dextrose and insulin infusion is titrated to blood sugar levels, according to the local protocol

Question 14

Poorly controlled blood sugars with gestation of T2DM during labour

Answer 14

A sliding-scale insulin regime is considered

Dextrose and insulin infusion is titrated to blood sugar levels, according to the local protocol

Question 15

Postnatal care for gestational diabetes

Answer 15

Can stop diabetes medication immediately after birth

F/u at 6 weeks

Question 16

Post natal care for women with existing diabetes

Answer 16

After birth, can lower insulin dose and be wary of hypoglycaemia in the postnatal period

Question 17

Risks to babies who’s mothers have diabetes

Answer 17

Neonatal hypoglycaemia
Polycythaemia (raised haemoglobin)
Jaundice (raised bilirubin)
Congenital heart disease
Cardiomyopathy

Question 18

Monitoring and management of neonatal hypoglycaemia

Answer 18

Regular blood glucose checks and frequent feeds.

Maintain blood sugar above 2 mmol/l, and if it falls below this, they may need IV dextrose of nasogastric feeding.