Gestational Diabetes Flashcards
How common is GDM and what is the breakdown?
1 in 20 pregnancies affected
87.5% have gestational diabetes
7.5% have type 1 diabetes
5% have type 2 diabetes
What are RFs for GDM?
BMI of > 30 kg/m²
previous macrosomic baby weighing 4.5 kg 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)
How is GDM screened?
OGTT at booking visit and at 24-28 weeks if first test normal.
What is diagnostic threshold for GDM?
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
How is GDM managed?
- Newly diagnosed women should be seen in a joint diabetes and antenatal clinic within a week
- Women should be taught about self-monitoring
- Advice about diet (including eating foods with a low glycaemic index) and exercise should be given
If fasting plasma glucose below or =7mmol/L -> trial of better diet and exercise
If target not met in 1-2 weeks -> altering diet/exercise metformin
If target still not met -> add short-acting insulin
f fasting plasma glucose >7mmol/L -> start insulin
If 6-6.9 mmol/l, and there is evidence of complications such as macrosomia or hydramnios -> insulin
Who is glibenclamide offered to?
Women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment
How is pre-existing diabetes managed in pregnant women?
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
What are blood glucose targets for diabetes during pregnancy?
Fasting 5.3 mmol/l
1 hour after meals 7.8 mmol/l, or:
2 hour after meals 6.4 mmol/l
