Gestational Diabetes

Question 1

what are the risk factors for gestational diabetes?

Answer 1

• BMI >30kg/m2
• previous macrosomic baby weight >/= 4.5kg
• previous gestational diabetes
• 1st degree relative with diabetes
• family origin with high prevalence of diabetes

Question 2

what is the screening test of choice for gestational diabetes?

Answer 2

oral glucose tolerance test (OGTT)

Question 3

when should women who’ve previous had gestational diabetes be screened?

Answer 3

• after booking
• first test normal = 24-28 weeks

Question 4

when should women with gestational diabetes risk factors be screened?

Answer 4

OGTT at 24-28 weeks

Question 5

what is the fasting glucose threshold for gestational diabetes?

Answer 5

> /= 5.6 mmol/L

5678 = fasting (5.6) –> 2-hour (7.8)

Question 6

what is the 2-hour glucose threshold for gestational diabetes?

Answer 6

> /= 7.8 mmol/L

5678 = fasting (5.6) –> 2-hour (7.8)

Question 7

what is the threshold for lifestyle control without medical management for fasting plasma glucose levels?

Answer 7

< 7 mmol/L

Question 8

how long should diet and exercise be trialled before no improvement leads to metformin being introduced?

Answer 8

1-2 weeks

Question 9

if metformin does not help, what is the next step in the management of gestational diabetes?

Answer 9

insulin

Question 10

what is the threshold for starting insulin at time of diagnosis for fasting plasma glucose levels?

Answer 10

>/= 7mmol/L

Question 11

what is the 2nd line medication if women cannot tolerate metformin?

Answer 11

glibenclamide

Question 12

what is the management for pre-existing diabetes in pregnancy?

Answer 12

• weight loss
• stop hypoglycaemic –> metformin + insulin started
• folic acid 5mg/day from pre-conception to 12 weeks
• anomaly scan at 20 weeks
• tight glycaemic control
• treat retinopathy

Question 13

what are the targets for glucose self-monitoring in pregnancy?

Answer 13

• fasting = 5.3
• 1 hour after meal = 7.8
• 2 hours after meal = 6.4