MSRA: Gestational Diabetes

Question 1

What are the indicators for performing an OGTT?

Answer 1

One or more of the following risk factors:
BMI greater than 30
Previous macrosomia/above 90th centile
Previous GDM
FHx
Ethnicity

OGTT at 24-28 weeks

Question 2

What are the normal results from an OGTT?

Answer 2

Fasting <5.6
2 hour <7.8

Question 3

What is the management of Gestational Diabetes?

Answer 3

Try D&L for 2 weeks
If no improvement add Metformin
If no improvement consider adding Insulin
Stop everything after birth
If fasting 7.0+ -> start Insulin straight away

Question 4

What are the maternal complications of gestational diabetes?

Answer 4

Increased risk of diabetes in later life – fasting glucose at 6-12 weeks post-partum

Question 5

What are the foetal complications of gestational diabetes?

Answer 5

Reflex hypoglycaemia - BMs checked every 2-4 hours
Macrosomia
Shoulder dystocia
Polyhydramnios

Question 6

What post-partum investigations are needed with gestational diabetes?

Answer 6

Fasting glucose at 6-12 weeks post-partum

• If less than 6, low risk of diabetes, annual check
• If between 6.0 and 6.9, high risk of developing diabetes
• If 7.0 and above, high risk of already having Type 2 diabetes, offer further testing

Question 7

What are the BM targets?

Answer 7

Before meals: 5.3
1 hour PP: 7.8
2 hour PP: 6.4

Question 8

For a woman with gestational diabetes in a previous pregnancy, when should an OGTT be performed?

Answer 8

As soon as possible after booking.
Repeat at 24-28 weeks if booking OGTT is normal