Gestational Diabetes

Question 1

What are risk factors?

Answer 1

BMI >30
Previous macrosomic baby >4.5kg
Previous GDM
1st degree relative with diabetes
Family origin with high prevelance diabetes

Question 2

How is GDM detected?

Answer 2

Oral glucose tolerance test
Those at risk have it performed routinely at 24-28 weeks

Question 3

What are the thresholds for diagnosis?

Answer 3

Fasting >5.6
2 hour glucose >7.8

Question 4

What is the management?

Answer 4

If fasting glucose <7
- trial of diet and exercise, if not working then metformin
- If not working then insulin

If fasting glucose >7 at time of diagnosis
- insulin should be started

If plasma glucose 6-6.9 and evidence of complications then insulin

Glibenclamide can be offered to women who do not tolerate metformin or who refuse insulin treatment

Question 5

What is the management for women with pre-existing diabetes?

Answer 5

Weight loss if BMI >27
Stop all diabetic meds except metformin and start insulin
Folic acid 5mg
Detailed anomaly scan at 20 weeks
tight sugar control
Treat retinopathy- can worsen in pregnancy

Question 6

What are target sugar levels?

Answer 6

Fasting= 5.3
1 hour after meals 7.8
2 hours after meals 6.4

Question 7

What are foetal complications?

Answer 7

Macrosomia
Should dystocia
RDS
Hypoglycaemia
Malformations
Stillbirth
Hypomagnesia/calcaemia
Polycythaemia- leading to jaundice