Gestational Diabetes Flashcards
What is GDM?
The onset of hyperglycemia in pregnancy where normal glucose metabolism returns following delivery.
What is Pederson’s Hypothesis?
Transplacental passage of glucose without the passage of insulin. This results in the fetal beta cells producing insulin resulting in beta cell hyperplasia and fetal hyperinsulinemia.
Ultimately results in the development of fetal fat and protein stores, causing macrosomia.
Why does GDM occur?
Placental hormones (HPL, insulinase, estrogen, progesterone, cortisol) - all have anti insulin effective on peripheral tissues.
Demographic RF for GDM
Age >40
African, South east asian, middle eastern
BMI >30
RF in current pregnancy for GDM
Glycosuria
Polyhydramnios
Baby >90th centile
PMH and FH RF for GDM
PMH:
PCOS and long term steroids
Prev. GDM
Prev Macrosomic baby
Prev stillborn
FH:
First degree relative with diabetes
Clinical features of GDM
Polyhydramnios
LFD
Glycosuria
When to screen for GDM
RF present - Ax 24-28
Prev hx of GDM - Ax 12/40
How to screen for GDM
Baseline BG after 8 hours fast
75g OGTT
1 hour post - BG measured
2 hour post - BG measured
Screened 6/52 post partum
Cut off scores for GDM
Baseline >5.1
>1hour >10
>2 hours >8.5
Any 1 of these met OR deranged result = GDM
Complications for baby in GDM?
SMS + RDS
Stillbirth
Macrosomia
Shoulder dystocia
RDS
Potential blood results in a baby with GDM
3 up:
Hyperinsulinemia, Hyperbilirubinemia, hyperphosphatemia
3 down:
Hypoglycemia
Hypocalcemia
Hypomagnasemia
Complications for the mother in GDM
POPIT
Polyhydramnios
Operative Delivery
PET
Infection
Trauma + tears + T2DM risk increased
How would DEMI mooRE manage GDM?
Diet + Diary + Dietitian
Exercise + education
Monitor (BP, SFH, diary) +/- metformin
Insulin
Refer to Endo
How to decide when to deliver a baby in GDM?
Diet controlled + no macrosomia - 39-40
Insulin well controlled + no macrosomia - 38-39
Uncontrolled - 37
If Spontaneous labour has not occurred by 41 weeks, offer IoL.
Sliding scale + steroids
Why is polyhydramnios an issue in GDM?
Stretches the uterus leading to:
1) PTL
2) Placental Abruption
3) Cord Collapse
When should a mother check their blood glucose routinely?
- Morning (fasted levels)
- 1 hour post-prandial
What happens at week 32-34 gestation?
Fetal biometry should be offered to all women with GDM to screen for LGA fetus to facilitate delivery planning
How are GDM patients monitored in the antenatal period?
Reviewed in 2 week intervals by diabetic/antenatal clinic until 34 weeks then weekly until delivery.
Weight, blood pressure, proteinuria and glycemic indices should be reviewed
How is GDM managed post-natally?
Insulin discontinued
Blood glucose monitoring stopped
OGTT after 6-12 weeks
Yearly fasting glucose with GP
