Gestational Diabetes Flashcards
1
Q
What is GDM?
A
- it is a glucose intolerance that is diagnosed during pregnancy
- during pregnancy fasting blood glucose concentration falls and postprandial glucose concentration rises up to 36 wks
—> from week 20 increasing levels of placental hormones are responsible for increasing maternal insulin resistance
—> if the woman has sufficient insulin secretory reserve then the rise in plasma glucose is minor, if she has limited reserve then glucose intolerance or diabetes may results
2
Q
What are the risk factors?
A
- BMI above 30
- first degree relative with diabetes
- previous macrosomic baby weighing 4.5Kg or above
- previous GDM
- family origin with high prevalence of diabetes
3
Q
What are some of the complications?
A
- polyhydramnios
- macrosomia
- hepatomegaly
- polycythaemia
- IUFD
- Hyaline membrane disease
- neonatal hypoglycaemia
4
Q
What is the treatment?
A
- lifestyle advice and home blood glucose monitoring
- oral anitdiabetic agents
- insulin treatment
5
Q
What is the role of the midwife?
A
- full explanation of GDM and the implications
- regular contact with specialist team (ensure growth scans)
- ensure plan for delivery has been made and is clearly documented in notes
- advise that target blood glucose levels before meals is <5mmol/l and <7mmol/l 1-2 hour post meal
6
Q
What is the role of the midwife postnatally?
A
- stop insulin immediately after delivery and monitor maternal blood glucose concentrations before meals for 24 hours
- if blood glucose >7mmol/l seek advice from diabetic team
- arrange rpt GTT at 6wks postpartum
- observe baby for signs of hypoglycaemia and monitor neonatal bloo glucose levels as per local policy
- encourage BF
- ensure understanding of increased risk of type 2 diabetes and advise about lifestyle modifications
