gestational diabetes

Question 1

risk factors for gestational diabetes

Answer 1

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)
unexplained stillbirth in a previous pregnancy

Question 2

screening for gestational diabetes

Answer 2

oral glucose tolerance test

Question 3

diagnostic thresholds for gestational diabetes

Answer 3

fasting glucose > 5.6 mmol/L
2-hour glucose > 7.8 mmol/L

Question 4

management of gestational diabetes

Answer 4

fasting plasma glucose < 7 = trial of diet and exercise
- if glucose target not met within 1-2 weeks start metformin, if still not met add insulin

if fasting glucose > 7 start insulin

Question 5

management for pre-existing diabetes

Answer 5

stop oral hypoglycaemic agents apart from metformin and commence insulin
folic acid until 12 weeks

Question 6

complications from gestational diabetes

Answer 6

neonatal hypoglycaemia
polycythaemia
jaundice
congenital heard disease
cardiomyopathy