Gestational Diabetes

Question 1

What is gestational diabetes?

Answer 1

Diabetes that develops during pregnancy

Question 2

What are the risk factors for gestational diabetes?

Answer 2

BMI >30 kg/m^2
Previous macrosomic baby weight 4.5kg or above
Previous gestational diabetes
First degree relative with diabetes
Family origin with high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)

Question 3

How is GD screened?

Answer 3

OGTT for women who have previously had GD (to be repeated if first test is normal at 16-24 weeks)
Women with any risk factors to be tested at 24-28 weeks

Question 4

What are the diagnostic thresholds for GD?

Answer 4

Fasting glucose >= 5.6mmol/L
2-hour glucose >= 7.8mmol/L

Question 5

What is the treatment for GD?

Answer 5

Lifestyle factors adjustment
If not glucose targets not met at 1-2 weeks - metformin to be started
If metformin alone not adequate - insulin to be added (not long-acting)
If at diagnosis fasting glucose is >=7mmol/L - insulin to be offered
If plasma glucose 6-6.9 mmol/L or evidence of macrosomia or hydramnios - insulin to be offered

Question 6

What can be offered if metformin is not tolerated / fail to meet targets and insulin is declined?

Answer 6

Glibenclamide

Question 7

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

Answer 7

Weight loss BMI >27 kg/m^2
Stop diabetic meds apart from metformin and start insulin
Folic acid 5mg/day from pre-conception to 12 weeks gestation
Detailed anomaly scan at 20 weeks including four-chamber view of heart and outflow tracts
Tight glycaemic control
Treat retinopathy as can worsen during pregnancy

Question 8

What are the self-monitoring targets for pregnant women?

Answer 8

Fasting 5.3 mmol/L
1 hour after meals 7.8 mmol/L
2 hours after meals 6.4 mmol/L