Gestational Diabetes

Question 1

Gestational Diabetes Definiton

Answer 1

Any degree of glucose intolerance with onset during pregnancy, resolving shortly after delivery

• Fasting glucose 5.6 or above
• Two hour glucose of 7.8 or above

Question 2

Gestational Diabetes Epidemiology

Answer 2

2-5% of pregnancies

Question 3

Gestational Diabetes RFs

Answer 3

Age, ethnic group, high BMI, smoking, change in weight between pregnancies, short interval between pregnancies,
-Protective; physical activity, bariatric surgery

Question 4

Gestational Diabetes Diagnosis

Answer 4

Offer screening to

• BMI>30, previous macrosomic baby, PHx, first degree relative, family origin
• Use two hour oral glucose tolerance test to test for GDM in women with RFs

Question 5

Gestational Diabetes Management

Answer 5

• Good glycemic control
• Trial changes in diet and exercise if fasting is below 7 at diagnosis
• Offer metformin if blood sugar targets are not met within 1-2 weeks
• Offer insulin if metformin is contra-indicated or not tolerated
• If over 7 at diagnosis or macrosomia or hydramnios, straight to insulin
• Insulin regimen
• HbA1c to assess previous diabetes, do not use to monitor control
• Offer scan to detect congenital malformations

Question 6

Gestational Diabetes Intrapartum Care

Answer 6

• Steroids are not contraindicated
• Do not use beta mimetic tocolytics
• Advise induction after 40+6
• VBAC is not contraindicated

Question 7

Gestational Diabetes Postpartum Care

Answer 7

• Discontinue treatment
• Offer fasting glucose test at 6-13 weeks to exclude diabetes, or HbA1c
• Further treatment according to blood sugar; if over 7 likely to have DMT2

Question 8

Gestational Diabetes Complications

Answer 8

Macrosomia, perinatal mortality, pre-eclampsia, C-section, shoulder dystocia, birth injuries, hypoglycaemia
-Sustained impairments of glucose tolerance, subsequent obesity, impaired intellectual achievement