Mx - Gestational Diabetes Flashcards
GDM complicates 5-10% of pregnancies. Risk factors for development of gestational diabetes are
Advanced maternal age Obesity Previous history of GDM or family history of diabetes PCOS ATSI
Screening for GDM
should take place at 26-28 weeks in the form of OGTT, fasting BGL followed by readings at 1 and 2 hours post 75 gram glucose drink.
Screening may take place earlier in high risk patients, or it may even be appropriate to screen for pre-existing type 2 diabetes in obese patients in early pregancy.
The diagnostic values for the OGTT are
BGL >=5.5 at fasting, >-8 at 2 hours
New values as of January 2015
If GDM is diagnosed, I would refer the patient to
a multidisciplinary team including obstetric medicine doctor, dietician and diabetes educator, who will educate the patient on self-monitoring of pre- and post-prandial blood glucose levels. The patient will need regular obstetrics appointments to monitor fetal growth.
50% of patients will achieve adequate sugar control with diet and exercise, but
insulin may be required with an individualised basal-bolus regime as prescribed by obstetrics medicine.
Fetal growth surveillance with USS is essential because of the risk of
macrosomia, as this can cause complicated delivery and shoulder dystocia which is an emergency.
The woman is also at increased risk of
pre-eclampsia - blood pressure should be monitored.
In the absence of additional complications, women with GDM may be booked for
induction of labour at 39 weeks or earlier based on estimated fetal weight, or may be booked for an elective caesarian section, as per obstetrician.
I would need to notify
the paediatric doctors when delivery is planned, because of the risk of neonatal hypoglycaemia.
Women should have a follow-up appointment
repeat the OGTT at 6 weeks, to ensure that it is normal. Women should also be counselled of their increased risk for future pregancies, as well as risk of type 2 diabetes in the future (1/2) which can be screened for 2 yearly with their GP.
