Gestational diabetes

Question 1

What are the diagnostic criteria for gestational diabetes?

Answer 1

Fasting plasma glucose ≥ 5.3 - 6.9 mmol/l.
Or
Plasma glucose ≥ 9.0 - 11.0 mmol/l 2 hours after 75 g oral glucose tolerance test (GTT).

Question 2

What is the most common diabetes during pregnancy?

Answer 2

Gestational diabetes.

Question 3

What are fetal complications of diabetes (non-gestational) in pregnancy?

Answer 3

Congenital malformation e.g. higher risk of caudal regression.
Miscarriage.
Stillbirth.
Neonatal death.
Intrauterine growth restriction.
Preterm birth.
Macrosomia, e.g. because of shoulder dystocia.
Birth Trauma.

Question 4

What are maternal complications of diabetes (non-gestational) in pregnancy?

Answer 4

Maternal morbidity is related to the severity of her diabetes preceding the pregnancy; as nephropathy and retinopathy that may progress.
Pre-eclampsia.
Infections.
Polyhydramnios.
Birth Trauma.
Induction of labor.
Caesarean section.

Question 5

What are risks associated with gestational diabetes?

Answer 5

Same risk for pre-eclampsia, macrosomia and birth trauma as for other types of diabetes.
Increased risk for developing diabetes later in life.

(No increased risk for congenital malformation.)

Question 6

When in pregnancy is oral glucose tolerance tests recommended and which women should take it?

Answer 6

In week 24-28.

Women with increased risk of gestational diabetes should take it:
Age > 25 years (age > 40 years in multipara with no previous GD).
BMI > 25 kg/m².
Previous gestational diabetes.
Family history of diabetes (parents, siblings).
Non-European ethnicity (from Asia or Africa).
For multiparous women: Obstetric complications associated with gestational diabetes
(e.g. birthweight > 4.5 kg, shoulder dystocia or preeklampsia

Question 7

A pregnant women takes an oral glucose tolerance test and two hours later her blood glucose is 11,9 mmol/L. What type of diabetes does she have?

Answer 7

Diabetes type 1 or 2. (Non-gestational.)

In gestational diabetes her glucose would have been over 9 mmol/L, but under 11,1 mmol/L.

Question 8

A pregnant women takes a blood test fasting and her glucose is 5,5 mmol/L. Does she have diabetes?

Answer 8

Yes, she has gestational diabetes. (Value for gestational diabetes 5,3-6,9 mmol/L.)

Question 9

A pregnant women takes an oral glucose tolerance test and two hours later her blood glucose is 8,4 mmol/L. Does she have diabetes?

Answer 9

No, she does not have diabetes. (Normal value < 9 mmol/L.)

Question 10

How should women with gestational diabetes be followed up after delivery?

Answer 10

Lifestyle advise for diet and exercise.
HbA1c 4 month after delivery.
HbA1c annually.

Question 11

Who should be screened for undiagnosed diabetes in the first trimester (around week 10, before week 16)?

Answer 11

Women with increased risk of diabetes:
Non-European ethnicity (from Asia or Africa).
Family history of diabetes (parents, siblings).
BMI > 30 kg/m².
For multiparous women: Obstetric complications associated with diabetes (e.g. birthweight > 4.5 kg, shoulder dystocia or pre-eclampsia).

Question 12

Which women should be reffered to a specialist based on their HbA1c-screening during the first trimester?

Answer 12

All women with HbA1c > 41 mmol/mol because they eihter have non-gestational diabetes or they have increased risk of developing gestational diabetes.

Sometimes women with gestational diabetes are followed by an experienced general practitioner. Women with non-gestational diabetes during pregnancy should be followed by a specialist.

Question 13

You work as a GP and have a consultation with a pregnant woman during the first trimester. The woman has a pre-pregnant BMI of 40. HbA1c is 38 mmol/mol. How should this woman be followed up?

Answer 13

Her HbA1c is < 41 mmol/mol. Based on HbA1c she is not recommended a referral because of increased risk for gestational diabetes. She should however be followed by her GP because of her BMI. A new consultation should be scheduled in about 4 weeks.

She should not gain much weight in the beginning of the pregnancy and no more than 5-9 kg during the entire pregnancy.

Question 14

Name some reasons a woman should not take an oral glucose test despite fulfilling the criteria for oral glucose test in week 24-28.

Answer 14

Non-gestational diabetes
Hyperemesis (sometimes)
Previous gastric bypass operation

Question 15

What kind of antidiabetic medicine can be used by during pregnancy?

Answer 15

Insulin

Metformin

Question 16

Dersom svangerskapsdiabetes avdekkes ved glukoebelastning i uke 24-28, hva er videre behandling?

Answer 16

Livsstilsråd de to første ukene og deretter ny glukosebelastning. Dersom fastende blodsukker > 5,3 mmol/l og/eller 2 timers 6,7 mmol/l henvisning til spesialist. Ny to ukers periode med forsøk på livstilsendringer. Dersom ikke effekt av dette kan medikamenter forsøkes.

Question 17

Hva er grensen for stort barn?

Answer 17

> 4,7 kg (tidligere grense > 4,5 kg)

Question 18

Hvor raskt kan man forvente seg at blodsukkeret normaliserer seg etter fødselen ved svangerskapsdiabetes?

Answer 18

Ganske rask

Ved normalisert fastende blodsukker etter fødsel kan antidiabetika seponeres