Pregnancy: diabetes mellitus Flashcards
What is gestational diabetes?
Gestational diabetes is a condition that may develop during pregnancy, complicating up to 1 in 20 pregnancies.
What percentage of pregnancies are affected by gestational diabetes?
Gestational diabetes affects around 4% of pregnancies.
What are the risk factors for gestational diabetes?
Risk factors include:
- BMI of > 30 kg/m²
- Previous macrosomic baby weighing 4.5 kg or above
- Previous gestational diabetes
- First-degree relative with diabetes
- Family origin with a high prevalence of diabetes (South Asian, black Caribbean, Middle Eastern)
What is the test of choice for screening gestational diabetes?
The oral glucose tolerance test (OGTT) is the test of choice.
When should women with previous gestational diabetes be screened?
OGTT should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.
What are the diagnostic thresholds for gestational diabetes?
Gestational diabetes is diagnosed if either:
- Fasting glucose is >= 5.6 mmol/L
- 2-hour glucose is >= 7.8 mmol/L
What is the management protocol for newly diagnosed gestational diabetes?
Newly diagnosed women should be seen in a joint diabetes and antenatal clinic within a week and taught about self-monitoring of blood glucose.
What dietary advice is given to women with gestational diabetes?
Advice about diet, including eating foods with a low glycaemic index, should be given.
What should be done if fasting plasma glucose level is < 7 mmol/L?
A trial of diet and exercise should be offered.
What is the treatment protocol if glucose targets are not met within 1-2 weeks?
If glucose targets are not met, metformin should be started.
What type of insulin is used to treat gestational diabetes?
Gestational diabetes is treated with short-acting, not long-acting, insulin.
What should be done if fasting glucose level is >= 7 mmol/L at diagnosis?
Insulin should be started.
What is the management for women with pre-existing diabetes?
Management includes weight loss for women with BMI of > 27 kg/m², stopping oral hypoglycaemic agents (except metformin), and commencing insulin.
What is the target for fasting blood glucose in pregnant women with diabetes?
The target for fasting blood glucose is 5.3 mmol/L.
What is the target for blood glucose 1 hour after meals?
The target is 7.8 mmol/L.
Targets for self monitoring of pregnant women (pre-existing and gestational diabetes)
