Gestational Diabetes

Question 1

Define gestational diabetes

Answer 1

Refers to diabetes triggered by pregnancy

Insulin resistance induced by metabolic strain of pregnancy

Question 2

Gestational diabetes is the second most common medical disorder complicating pregnancy.

What is the first

Answer 2

Hypertension

Question 3

When does gestational diabetes resolves

Answer 3

Resolves after birth however risk of developing T2DM

Question 4

Name two foetal complications of gestational diabetes

Answer 4

• Macrosomia – larger foetus
• Risk of shoulder dystocia

Question 5

What is shoulder dystocia

Answer 5

This is when the head has been born but the baby’s shoulders are stuck behind the maternal pubic bone

Question 6

What is a maternal complication of gestational diabetes

Answer 6

Increase risk of developing T2DM

Question 7

Name some of the risk factors for gestational diabetes

Answer 7

• Previous gestational diabetes
• Previous macrosomic baby (≥ 4.5kg)
• High BMI (> 30 kg/m²)
• Ethnic origin (black Caribbean, Middle Eastern and South Asian)
• Family history of diabetes (first-degree relative)

Question 8

What is the gold standard investigation for gestational diabetes

Answer 8

Oral glucose tolerance test (OGTT)

Question 9

What test is used to screen for gestational diabetes

Answer 9

Oral glucose tolerance test (OGTT)

Question 10

Who should be screened for gestational diabetes

Answer 10

Anyone with risk factors should be screened at 24 – 28 weeks gestation

Anyone with features suggestive of gestational diabetes

Question 11

What are the three features suggestive of gestational diabetes

Answer 11

Large for dates foetus

Polyhydramnios (increased amniotic fluid)

Glucose on urine dipstick

Question 12

What is the diagnostic threshold for gestational diabetes

Answer 12

Fasting: >= 5.6mmol/l

At 2 hours >= 7.8 mmol/l

Note: Remember cut off as 5-6-7-8

Question 13

When should an oral glucose tolerance test be performed

Answer 13

Performed in the morning after a fast

Question 14

In oral glucose tolerance test blood glucose levels are measured at the start of the test and after how many hours?

Answer 14

After 2 hours

Question 15

At what stage of the pregnancy should woman be screened for gestational diabetes

Answer 15

24 – 28 weeks gestation

Question 16

Name some of the non-pharmaceutical management of gestational diabetes

Answer 16

Women should be taught about self-monitoring of blood glucose

Advice about diet (including eating foods with a low glycaemic index) and exercise should be given

Between 28-36 weeks gestation – four weekly US scans to monitor foetal growth and amniotic fluid volume

Question 17

What is the fasting glucose cut off’s for management and what are the management options for each stage

Answer 17

Fasting glucose <7 mmol/l –

• Initially diet, exercise
• If still resistant – Add metformin
• If still resistant – Add insulin

Fasting glucose >7 mmol/l –

• Diet, exercise + insulin ± metformin

Fasting glucose >6 mmol/l with complications –

• Diet, exercise + insulin ± metformin