Gestational diabetes

Question 1

What are RFs

Answer 1

• BMI >30
• Previous macrosomic baby >4.5kg
• Prev. GD
• 1st degree relative w DM
• South Asian, black Caribbean and Middle Eastern

Question 2

If women have previously had GD, how are they screened in a subsequent pregnancy for it?

Answer 2

→ Oral glucose tolerance test should be performed ASAP after booking and at 24-28 weeks if the first test is normal
Or
→ Early self-monitoring of blood glucose

Question 3

What should be offered for women w any other RFs of GD?

Answer 3

an OGTT at 24-28 weeks

Question 4

what are the diagnostic thresholds for GD?

Answer 4

♣ Fasting glucose ≥5.6mmol/l

♣ 2hr glucose ≥7.8mmol/l

Question 5

When should metformin be offered in GD

Answer 5

If glucose targets aren’t met within 1-2 weeks of altering diet/exercise

Question 6

When should insulin be offered in the management of GD?

Answer 6

If glucose targets not met w metformin
or
if at the time of diagnosis fasting glucose is 7 or insulin
or
If plasma glucose level is between 6-6.9mmol/l + evidence of complications such as macrosomia or hydramnios

Question 7

What should be given if metformin isn’t tolerated or they decline insulin

Answer 7

glibenclamide

Question 8

When should growth scans be done in GD

Answer 8

every 4 weeks from 28 weeks

Question 9

What indicates referral to nephrologist?

Answer 9

Creatinine >120µmol/L, protein excretion >2g/24hr

Question 10

When is the latest a woman should give birth if they haveGD?

Answer 10

40+6 weeks

Question 11

When should fasting glucose be checked after birth?

Answer 11

6 weeks postpartum

Question 12

What HbA1c should be aimed for in pre-existing DM??

Answer 12

43 or less

Question 13

When is weight loss recommended in pre-existing DM?

Answer 13

if bmi >27

Question 14

What medical management should be done if someone w pre-existing diabetes becomes pregnant?

Answer 14

stop oral hypoglycaemic agents except metformin
commence insulin
stop statins, acei and A2Ai
folic acid 5mg/day from pre-conception to 12 weeks

Question 15

When should pregnancy be avoided in a woman w diabetes?

Answer 15

if they have severe nephropathy

Question 16

How should the fetus be monitored in a woman w pre-existing DM who becomes pregnant?

Answer 16

Detailed anomaly scan at 20 weeks w four chamber view of heart and outflow tracts

Question 17

When should birth be organised for a woman with preexisting DM who becomes pregnant?

Answer 17

Elective by IOL or CS between 37-38+6w

Question 18

What is the management at delivery if DM pregnant woman is preterm?

Answer 18

give corticosteroids to promote fetal lung maturity

Question 19

What glucose level should be aimed for at delivery?

Answer 19

4-7mmol/l

Question 20

When should a sliding scale be used at delivery?

Answer 20

if insulin dependent DM
or
capillary blood glucose >7mmol/l in GDM

Question 21

How should medical management of GDM and T2 change at delivery?

Answer 21

stop insulin infusion

return to pre-pregnancy regimen

Question 22

Which hypoglycaemic should be avoided when breastfeeding, why?

Answer 22

sulfonylureas due to risk of neonatal hypoglycaemia

Question 23

What is fasting target of BM

Answer 23

5.3mmol/l

Question 24

what is target BM 1 hr after meals

Answer 24

7.8mmol/l

Question 25

what is target BM 2hr after meals

Answer 25

6.4

Question 26

What are maternal complications of gdm?

Answer 26

− Hypoglycaemia unawareness
− risk of pre-eclampsia
− risk of infection
rate of LSCS

Question 27

What are fetal complications of gdm?

Answer 27

−	Miscarriage
−	Malformation 
−	Macrosomia so  risk of shoulder dystocia
−	IUGR 
−	Polyhydramnios
−	Preterm labour 
Stillbirth

Question 28

why does macrosomia occur?

Answer 28

pancreatic islet cell hyperplasia leading to hyperinsulinaemia and fat deposition

Question 29

what are signs of macrosomia

Answer 29

increased UO and polyhydramnios (increased liquor)