gestational diabetes Flashcards
pathophysiology of gestational diabetes
- During pregnancy, there is an increase in the insulin requirements of the mother
- HPL, Progesterone, hCG, and cortisol have an anti-insulin action
risk factors of gestational diabetes
- ncreased BMI >30
- Previous macrosomic baby > 4.5kg
- Previous GDM
- Family history of diabetes
- Women from high risk groups for developing diabetes – eg. Asian origin
- Polyhydramnios or big baby in current pregnancy
- Recurrent glycosuria in current pregnancy
foetal complications of gestational diabetes
- Macrosomia and Shoulder dystocia
- Polyhydramnios (too much amniotic fluid around the baby)
- Foetal congenital abnormalities (Cardiac abnormalities, Sacral agenesis)
- Miscarriage
neonatal complications of gestational diabetes
- Respiratory distress (Impaired lung maturity)
- Neonatal hypoglycemia
- Jaundice
maternal complications of gestational diabetes
- Pre-eclampsia
- Maternal nephropathy, retinopathy, neuropathy
- Hypoglycaemia
- Infections
diagnosis of GDM
OGTT at 24-28 weeks
fasting GTT>5.6 mmol/L or glucose >7.8 mmol/L after GGT (5678 rule)
if RFs present then offer HbA1c to screen. if result >6% (43mmol/mol) OGTT to be done. if normal then repeat at 24-28 weeks
if significant RF then offer OGTT at 16 weeks and again at 28 weeks
management of gestational diabetes
- Metformin
- Insulin (if fasting glucose >7 mmol/L)
in 38-40weeks till birth
induction of labour
elective C section if fetal or significant macrosomia
insulin and dextrose infusion during labour
early feeding of baby to reduce neonatal hypoglycaemia
check ogtt 6-8 weeks after and manage with diet or medication if sugars remain high. yearly check of HbA1c after
optimal glycaemic control
- < 5.3 mmol/l — Fasting
- < 7.8 mmol/l — 1 hour postprandial
- < 6.4 mmol/l — 2 hours postprandial
- < 6 mmol/l — before bedtime
