Gestational diabetes

Question 1

About Gestational Diabetes

Answer 1

diabetes mellitus may be a pre-existing problem or develop during pregnancy (gestational diabetes)

2nd most common medial disorder complication pregnancy (after hypertension) - affects around 4% of pregnancies

Question 2

Risk factors for gestational diabetes?

Answer 2

BMI of >30kg/m2

Previous macrosomic baby weighting 4.5kg or above

Previous gestational diabetes

First-degree relative with diabetes

Family origin with a high prevalence of diabetes (south asian, black caribbean, and middle eastern)

Question 3

Screening for gestational diabetes

Answer 3

the oral glucose tolerance test (OGTT) is the test of choice

women who’ve previously had gestational diabetes: OGTT should be preformed as soon as possible after booking and 24-28 weeks if the first test is normal. NICE recommend that early self-monitoring of blood glucose is an alternative to the OGTTs

women with any of the risk factors should be offered a OGTT at 24-28 weeks

Question 4

Diagnostic thresholds for gestational diabetes

Answer 4

gestational diabetes is diagnosed if either:

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

Question 5

Management of gestational diabetes
newly diagnosed women: admin/advice

Answer 5

should be seen in a joint diabetes and antenatal clinic within a week

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

Question 6

Management: if the fasting plasma glucose level is < 7 mmol/l

Answer 6

a trial of diet and exercise should be offered

Question 7

if glucose targets are not met within 1-2 weeks of altering diet/exercise, what should be done?

Answer 7

Metformin should be started

If glucose targets are still not met - insulin should be added to diet/exercise/metformin

Question 8

what type of insulin is gestational diabetes treated with?

Answer 8

short acting (not long-acting)

Question 9

If at the time of diagnosis, the fasting glucose level is > = 7mmol/l?

Answer 9

insulin should be started straight away

Question 10

if the plasma glucose level is between 6-6.9 mmol/l, and there is evidence of complications such as macrosomia or hydramnios?

Answer 10

insulin should be offered

Question 11

women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment? what treatment should be used?

Answer 11

Glibenclamide - a sulfonylurea

Question 12

Management of pre-existing diabetes

Answer 12

Weight loss for women with BMI of > 27 kg/m^2

Stop oral hypoglycaemic agents, apart from metformin, and commence insulin

Folic acid 5 mg/day from pre-conception to 12 weeks gestation

Detailed anomaly scan at 20 weeks including four-chamber view of the heart and outflow tracts

Tight glycaemic control reduces complication rates

Treat retinopathy as can worsen during pregnancy

Question 13

Targets for self monitoring of pregnant women (pre-existing and gestational diabetes)

Answer 13

Fasting = 5.3 mmol/l

1h after meals = 7.8 mmol/l

2h after meals = 6.4 mmol/l