Gestational diabetes

Question 1

What causes gestational diabetes?

Answer 1

Progesterone and hPL can induce insulin resistance. If this occurs in already predisposed individual can get increased blood glucose.

Question 2

What complications can the foetus get from poorly controlled blood glucose?

Answer 2

Congenital malformations
Premature birth
Intrauterine growth retardation (IUGR)
Macrosomia
Intrauterine death

Question 3

What congenital malformations are common with poorly controlled blood glucose?

Answer 3

Spina bifida

Caudal regression syndrome

Question 4

What is macrosomia?

Answer 4

Maternal hyperglycemia -> Foetal hyperglycemia -> Foetal hyperinsulinemia.
As insulin is a growth hormone get increased birth weight (>4kg)

Question 5

How should you generally manage all forms of diabetes in pregnancy?

Answer 5

Counselling: Good sugar control/diet
Premeal glucose 4-5.5, postmeal 6.5-7
5mg folic acid daily
Regular eye checks (10, 20 and 30 weeks)
Avoid ACEI and statins

Question 6

What drug treatment is recommended for T1, T2 and GDM sufferers during pregnancy?

Answer 6

T1- Insulin
T2- Metformin +/- insulin
GDM- Life style, metformin +/- insulin

Question 7

How long can GDM take to recover after birth?

Answer 7

Upto 6 weeks. If lasts longer it is T2DM