Gestational DIabetes

Question 1

What is gestational diabetes

Answer 1

State of insulin resistance induced by the metabolic strain of pregnancy. Hormones produced by the pregnancy result in reduced insulin production by the pancreas.

Question 2

What are the risk factors gestational diabetes?

Answer 2

• Ethnicity: Middle eastern, South Asian and Afro-Caribbean,
• Previous GDM
• Large babies > 4.5kg
• Previous stillbirth
• Maternal obesity
• Family history of diabetes

Question 3

How can you screen for gestational diabetes?

Answer 3

• Oral glucose tolerance test.
• Diagnostic thresholds are: Fasting glucose >=5.6 or 2-hour glucose >=7.8
  Remembered by ‘diagnosis of GDM is as easy as 5678’

Question 4

What is the management of gestational diabetes?

Answer 4

• Diet and exercise
• Insulin if fasting glucose >= 7
• Insulin if evidence of pregnancy complications

Question 5

What are the foetal complications of gestational diabetes?

Answer 5

• Macrosomia (>4kg),
• Preterm delivery
• Newborn hypoglycemia (can lead to seizures)

Question 6

What are the maternal complications of gestational diabetes?

Answer 6

Increased risk of hypertension, pre-eclampsia, T2DM and future GDM.

Question 7

What are the symptoms of gestational diabetes?

Answer 7

Polyuria
Thirst
Fatigue

Question 8

What is the management of gestational diabetes? (according to passmed)

Answer 8

If fasting glucose < 7mmol/l
1. Trial Dietary advice
2. If not worked in 1-2 weeks then add metformin
3. If still not met then add insulin.
If fasting glucose is > 7mmol/l then insulin should be started