Gestational Diabetes

Question 1

What is gestational diabetes?

Answer 1

Glucose intolerance of varying severity with first diagnosis during pregnancy and resolution following pregnancy

Question 2

Why are women with GDM admitted to hospital?

Answer 2

1. Reduced foetal movements
2. Poor control
3. IOL
4. Steroids at 35-36w if elective C-section

Question 3

What are indicators of poor control in GDM?

Answer 3

Glycosuria/ketones on urine dipstick
High blood sugar readings
LFD baby

Question 4

What are the risk factors for GDM?

Answer 4

Demographic
- maternal age >40
- BMI >30
- ethnicity (South Asia, Middle East, Afro-Carribean)

Obstetric History
- LFD baby/polyhydramnios
- glycosuria
- history of GDM
- previous baby >4.5kg
- stillbirth of unknown cause

Medical History
- PCOS
- long-term steroid use

Family History
- first degree relative

Question 5

When is the OGTT performed? When is it performed earlier?

Answer 5

28 weeks; performed at 12 weeks if history of GDM

Question 6

How is the OGTT performed?

Answer 6

Patient fasting for 8 hours
Fasting bloods taken
75g glucose load
1 hour bloods
2 hour bloods

Question 7

What are the fasting, 1 hour and 2 hour readings that indicate GDM on OGTT?

Answer 7

Fasting >5.1
1 hour >10
2 hour >8.5

Question 8

How is GDM managed? (DEMI MooRE)

Answer 8

Diet/exercise (trial 2 weeks)
Education
Monitoring (sugars, glucose diary, antenatal clinic)
Insulin

Make plan for delivery
o
o
Refer to
Endocrinologist

Question 9

When are blood sugars measured in GDM? What insulin products are used?

Answer 9

Seven times per day (before and after each meal, once at night)

Short acting three times per day (Novorapid)
Long acting insulin once a day (Levemir)

Question 10

What are the maternal complications of GDM?

Answer 10

1. Polyhydramnios (PTL, placental abruption, prolapse of cord)
2. C-section
3. Perineal tear
4. PET
5. Recurrence of GDM or T2DM (50%)

Question 11

What are the foetal complications of GDM?

Answer 11

Still birth
Macrosomia/shoulder dystocia
RDS (if premature)
Hyperinsulinaemia
Hyperbilirubinaemia
Hyperphosphataemia
Hypoglycaemia
Hypocalcaemia
Hypomagnesia

Question 12

What three things go up in a GDM baby?

Answer 12

Hyperinsulinaemia
Hyperbilirubinaemia
Hyperphosphataemia

Question 13

What three things go down in a GDM baby?

Answer 13

Hypoglycaemia
Hypocalcaemia
Hypomagnesia

Question 14

If a GDM patient is receiving steroids, how are their blood sugars managed?

Answer 14

Sliding scale insulin

Question 15

When are a) well-controlled GDM b) poorly-controlled GDM patients delivered?

Answer 15

a) IOL at 38-39 weeks
b) IOL at 37-38 weeks

Question 16

How is a baby >4.5kg delivered? What precautions must be taken?

Answer 16

Elective C-section

Steroids at 35-36 weeks