Gestational Diabetes History & Counselling

Question 1

What % of pregnancies are affected by GDM?

Answer 1

1 in 20

Question 2

Risk factors for gestational diabetes?

Answer 2

• Previous GDM
• BMI >30
• Previous macrosomic baby (≥4.5kg)
• 1st degree relative with diabetes
• Asian ethnicity

Question 3

What is GDM?

Answer 3

Glucose intolerance which has been triggered by pregnancy.

Note - will resolve AFTER pregnancy.

Question 4

When is OGTT done in:

a) women who’ve previously had GDM

b) women with any of the other risk factors for GDM

Answer 4

a) ASAP after booking, again at 24-28w (if 1st test is normal)

b) OGTT at 24-28w

Question 5

Give some foetal complications of GDM

Answer 5

1) IUGR & stillbirth

2) Macrosomia

3) Neonatal hypoglycaemia

4) Shoulder dystocia (nerve palsies)

5) Increased risk of T2DM in later life

Question 6

Give some maternal complications of GDM

Answer 6

1) HTN/pre-eclampsia

2) Macrosomia: increased risk of tears, PPH

3) Shoulder dystocia: tears, traum

4) Increased chance of instrumental delivery

5) Increased chance of needing c-section

6) Increased risk of GDM in future pregnancy

7) Increased risk of T2DM in later life

Question 7

Mx options in GDM

Answer 7

1) Consultant led care - ‘high risk’ pregnancy

2) Diet, lifestyle & exercise measures

3) Women should be taught about self-monitoring of blood glucose

4) Metformin +/- insulin (depends on OGTT results)

5) Serial growth scans: 4 weekly growth scans

6) Review by diabetes team every 1-2 weeks

7) Timing of delivery: dependent on seveity

8) Monitoring of neonate for 24h after birth for hypoglycaemia

9) Medication typically stops after delivery of baby