Gestational_Diabetes_Flashcards
What is the recommended antenatal care for women with gestational diabetes?
Offer a review with the joint diabetes and antenatal clinic within 1 week, and clinics should be in contact with women with diabetes every 1 to 2 weeks throughout pregnancy.
What are the blood glucose targets for women with gestational diabetes?
Aim for <5.3 mmol/L when fasting, <7.8 mmol/L 1 hour after meals, and <6.4 mmol/L 2 hours after meals. Women taking insulin should maintain their capillary plasma glucose above 4 mmol/L.
How should women with T2DM or gestational diabetes on a multiple daily insulin injection regimen monitor their blood glucose?
Measure fasting, pre-meal, 1-hour post-meal, and bedtime blood glucose.
How should women with T2DM or gestational diabetes managing their diabetes with diet, exercise, or oral therapy monitor their blood glucose?
Measure fasting and 1-hour post-meal blood glucose.
What is the recommended frequency of growth scans for women with gestational diabetes?
Serial growth scans are recommended every 4 weeks from 28-36 weeks gestation.
What is the first-line treatment for gestational diabetes if fasting blood glucose is <7 mmol/L?
First-line treatment is changes in diet and exercise, with a focus on low glycaemic index foods, referral to a dietician, and regular exercise.
What should be done if glucose targets are not met by diet and exercise after 1-2 weeks?
Start metformin if glucose targets are not met by diet and exercise after 1-2 weeks.
What is the second-line treatment for gestational diabetes if metformin is contraindicated?
If metformin is contraindicated, go straight for insulin.
What is the third-line treatment for gestational diabetes if diet, exercise, and metformin are ineffective?
Add insulin if diet, exercise, and metformin are ineffective. Consider glibenclamide (a sulphonylurea) in women who fail to meet glucose targets on metformin and decline insulin therapy.
What is the management if fasting glucose at diagnosis is >7 mmol/L or 6-6.9 mmol/L with complications?
Offer insulin straight away +/- metformin.
When should elective birth be organised for women with gestational diabetes?
Elective birth should be organised for no later than 40+6 weeks gestation. If not given birth by 40+6 weeks, offer induction of labour or C-section.
What postnatal care is recommended for women with gestational diabetes?
Discontinue blood glucose lowering treatment immediately after delivery. Monitor BP, and continue antenatal antihypertensive treatment if required.
How should the baby’s blood glucose be managed postnatally if the mother had gestational diabetes?
Assess the baby’s blood glucose 2-4 hours after birth and encourage early feeding to prevent hypoglycaemia.
What is the postnatal monitoring for women with gestational diabetes?
Measure fasting blood glucose at 6-13 weeks postnatal (or HbA1c if after 13 weeks) to exclude new diagnosis of diabetes. Offer annual HbA1c and diet and lifestyle advice based on the results.
What follow-up is recommended for women with gestational diabetes in future pregnancies?
Offer early OGTT in subsequent pregnancies (as soon as possible after booking, and again at 24-28 weeks gestation if the results of the first screening are normal).
