Gestational diabetes Flashcards
What are RFs
- BMI >30
- Previous macrosomic baby >4.5kg
- Prev. GD
- 1st degree relative w DM
- South Asian, black Caribbean and Middle Eastern
If women have previously had GD, how are they screened in a subsequent pregnancy for it?
→ 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
What should be offered for women w any other RFs of GD?
an OGTT at 24-28 weeks
what are the diagnostic thresholds for GD?
♣ Fasting glucose ≥5.6mmol/l
♣ 2hr glucose ≥7.8mmol/l
When should metformin be offered in GD
If glucose targets aren’t met within 1-2 weeks of altering diet/exercise
When should insulin be offered in the management of GD?
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
What should be given if metformin isn’t tolerated or they decline insulin
glibenclamide
When should growth scans be done in GD
every 4 weeks from 28 weeks
What indicates referral to nephrologist?
Creatinine >120µmol/L, protein excretion >2g/24hr
When is the latest a woman should give birth if they haveGD?
40+6 weeks
When should fasting glucose be checked after birth?
6 weeks postpartum
What HbA1c should be aimed for in pre-existing DM??
43 or less
When is weight loss recommended in pre-existing DM?
if bmi >27
What medical management should be done if someone w pre-existing diabetes becomes pregnant?
stop oral hypoglycaemic agents except metformin
commence insulin
stop statins, acei and A2Ai
folic acid 5mg/day from pre-conception to 12 weeks
When should pregnancy be avoided in a woman w diabetes?
if they have severe nephropathy
How should the fetus be monitored in a woman w pre-existing DM who becomes pregnant?
Detailed anomaly scan at 20 weeks w four chamber view of heart and outflow tracts
When should birth be organised for a woman with preexisting DM who becomes pregnant?
Elective by IOL or CS between 37-38+6w
What is the management at delivery if DM pregnant woman is preterm?
give corticosteroids to promote fetal lung maturity
What glucose level should be aimed for at delivery?
4-7mmol/l
When should a sliding scale be used at delivery?
if insulin dependent DM
or
capillary blood glucose >7mmol/l in GDM
How should medical management of GDM and T2 change at delivery?
stop insulin infusion
return to pre-pregnancy regimen
Which hypoglycaemic should be avoided when breastfeeding, why?
sulfonylureas due to risk of neonatal hypoglycaemia
What is fasting target of BM
5.3mmol/l
what is target BM 1 hr after meals
7.8mmol/l
what is target BM 2hr after meals
6.4
What are maternal complications of gdm?
− Hypoglycaemia unawareness
− risk of pre-eclampsia
− risk of infection
rate of LSCS
What are fetal complications of gdm?
− Miscarriage − Malformation − Macrosomia so risk of shoulder dystocia − IUGR − Polyhydramnios − Preterm labour Stillbirth
why does macrosomia occur?
pancreatic islet cell hyperplasia leading to hyperinsulinaemia and fat deposition
what are signs of macrosomia
increased UO and polyhydramnios (increased liquor)
