Gestational Diabetes

Question 1

What is Gestational Diabetes?

Answer 1

Diabetes triggered by pregnancy

Question 2

What percentage of Pregnant women will have GD?

Answer 2

20%

Question 3

What is GD caused by?

Answer 3

Progressively reduced insulin sensitivity @ pregnancy

Question 4

Does GD resolve @ birth?

Answer 4

Yes

Question 5

What are the RF for GD? (6 things)

Answer 5

1. Previous GD
2. Previous Macroscomic baby (4.5kg +)
3. BMI 30+
4. Caribbean / Middle Eastern / South Asian
5. FHx of DM
6. PCOS

Question 6

If a pregnant woman has RF for GD, what should happen?

Answer 6

Oral Glucose Tolerance Test (OGTT) @ 24-28 weeks

Question 7

If a pregnant woman has previously had GD, what should happen?

Answer 7

OGTT after Booking Clinic

Question 8

What CF could suggest GD? (3 things)

Answer 8

1. Large for GA
2. Polyhydramnios
3. Glucose on Urine dipstick

Question 9

What are the CF of GD? (4 things)

Answer 9

1. Asymptomatic (most woman w pancreatic reserve)
2. Polyuria
3. Polydipsia
4. Fatigue

Question 10

What is the NICE recommendation for a GD woman with Fasting glucose less than 7? (3 things) (IN ORDER)

Answer 10

1. Diet + Exercise Trial for 1-2 wks
2. Metformin
3. Insulin

Question 11

What is the NICE recommendation for a GD woman with Fasting glucose of 7+? (2 things) (IN ORDER)

Answer 11

1. Insulin
2. Metformin

Question 12

What is the NICE recommendation for a GD woman with Fasting glucose of 6+ + Macrosomia / Other complications? (2 things) (IN ORDER)

Answer 12

1. Insulin
2. Metformin

Question 13

What can you give women who decline Insulin / Can’t tolerate Metformin?

Answer 13

Glibenclamide (a Sulfonylurea)

Question 14

What monitoring scans do GD women need during pregnancy?

Answer 14

US scans every 4 weeks (from 28-36 weeks)

Question 15

What is monitored in the US scans every 4 weeks for a GD woman? (2 things)

Answer 15

1. Foetal growth
2. Amniotic fluid volume

Question 16

When should a woman aim to deliver if her GD is managed by Treatment?

Answer 16

37-38 weeks

Question 17

When should a woman aim to deliver if her GD is managed by Diet?

Answer 17

B4 40+6 weeks

Question 18

What type of delivery should a woman w GD managed by Diet be advised to have? (2 things)

Answer 18

1. Induction of labour
2. C section

Question 19

When can a GD woman stop her GD medication?

Answer 19

Immediately after birth

Question 20

What should be checked before a GD woman is discharged?

Answer 20

Blood glucose

(to check it has returned to normal levels)

Question 21

What are GD women at risk of developing in future?

Answer 21

DM

Question 22

What percentage of GD women will develop T2DM in future?

Answer 22

50%

Question 23

What should you do to monitor risk of developing DM in GD women?

Answer 23

Fasting glucose test 6-13 weeks after giving birth

Question 24

If the Fasting glucose test 6-13 weeks after giving birth is normal, what should you do?

Answer 24

Offer yearly tests

(bc still risk of developing DM in future)

Question 25

What are babies of GD woman at risk of? (6 things)

Answer 25

1. **Macrosomia** 2. **Neonatal hypoglycaemia** 3. Polycythaemia 4. Jaundice 5. Congenital HD 6. Cardiomyopathy

Question 26

How do you manage the risk of a baby of a GD woman developing Neonatal hypoglycaemia? (2 things)

Answer 26

1. Regular blood glucose checks 2. Frequent feeds

Question 27

What should you give if the baby’s Blood Glucose drops below 2?

Answer 27

IV dextrose (via NG tube)