Gestational diabetes

Question 1

During pregnancy, the mother doesn’t store sugar as all the sugar is passed on to the developing foetus. True or false?

Answer 1

True

Question 2

How does gestational diabetes occur?

Answer 2

If hormone levels go up in predisposed mothers, this can raise blood glucose levels, leading to gestational diabetes

Question 3

When does the foetus start producing its own insulin?

Answer 3

3rd trimester

Question 4

What is gestational diabetes?

Answer 4

Any degree of glucose intolerance arising or diagnosed during pregnancy

Question 5

Risk factors

Answer 5

Previous gestational diabetes 
Obesity 
First degree relative affected 
Previous macrosomia 
Polyhydramnios 
Glycosuria

Question 6

If risk factors are detected at booking appointment, which investigations are required?

Answer 6

Blood glucose monitoring

• fasting BGM >5.1mmol/l
• 2 hour BGM >8.5mmol/l

OR

Oral GTT

Question 7

Management

Answer 7

Diabetic diet 
Aim for good blood sugar control
Monitor HbA1c
Monitor BP 
Metformin

Question 8

Gestational diabetes always resolves post natally. True or false?

Answer 8

True

Question 9

You are more likely to develop T2DM in later life if you have gestational diabetes. True or false?

Answer 9

True

Question 10

Complications

Answer 10

Pre-elcampsia
Polyhydramnios
Intra uterine death
Macrosomia

Question 11

Problems in the baby

Answer 11

High birth weight
Respiratory distress
Hypoglycaemia (fits)
Spina bifida

Question 12

Babies will have normal/reduced/increased growth. Why is this ?

Answer 12

Normal

- glucose can cross the placenta but insulin can’t

Question 13

Timing of delivery - 38 weeks

Answer 13

Insulin treatment

Question 14

Timing of delivery - 39-40 weeks

Answer 14

Metformin treatmen t

Question 15

Timing of delivery - 40-41 weeks

Answer 15

Diet alone

Question 16

Pre-existing diabetes. Why is pre-pregnancy counselling important?

Answer 16

Plan pregnancy
HbA1c monitoring - aim for 48mmol/mol
Need monthly scanning from 28 weeks

Question 17

What should be given to the mother 3 months before conception –> first 12 weeks gestation?

Answer 17

Folic acid (5mg)

Question 18

What should be given from 12 weeks gestation?

Answer 18

Low dose aspirin

Question 19

There is accelerated retinopathy rate during pregnancy in pre-diabetics. True or false?

Answer 19

True

Question 20

Which 2 cardiovascular medications should be avoided during pregnancy as they can cause congenital malformations?

Answer 20

ACE inhibitors

Statins

Question 21

When should you aim for delivery in a patient with pre-pregnancy diabetes ?

Answer 21

38 weeks

Question 22

For patients with pre-existing diabetes (type 1 or 2) what does of folic acid should they be given and when?

Answer 22

high dose (5mg) folic acid 3 months before conception -> 12 weeks