Diabetes

Question 1

What is the routine screening available for diabetes?

Answer 1

HbA1c at booking should be <40 mmol/mol if over 50 they have undiagnosed diabetes
At 24-28 weeks Glucose challenge test should be >7.8mmol/L

Question 2

How can routine screening be altered if diabetes is suspected?

Answer 2

If HbA1c is 41-49 or the woman is considered high risk, you go straight to Oral Glucose Tolerance Test which should be >5.5 fasting or >9 at 2 hours.

Question 3

What do you do if glucose challenge test is greater than 7.8?

Answer 3

Give oral glucose tolerance test

Question 4

What is involved in the diabetes in pregnancy pathway?

Answer 4

Weight and lifestyle advice/nutrition
Ultrasound on diagnosis
Metformin and or insulin
Glucose targets <5 fasting <7.4mmol/L 1 hour prandial
Normal delivery or delivery at 38-39 weeks if problems arise
HbA1c 3 months post partum and annually thereafter

Question 5

What are the risk factors for gestational diabetes?

Answer 5

Previous gestational diabetes
Previous LGA baby
Age >40
Obesity

Question 6

What are the maternal complications of GDM?

Answer 6

Preeclampsia
Need for Caesarean
Type 2 diabetes

Question 7

What are the complications of gestational diabetes on the infant?

Answer 7

Shoulder dystocia
Preterm birth
Still birth
LGA