gestational diabetes

Question 1

risk factors for gestational diabetes

Answer 1

BMI >30
previous macrosomic baby
previous gestational diabetes
1st deg relative with diabetes
unexplained stillbirth in a previous pregnancy

Question 2

screening for gestational diabetes

Answer 2

OGTT = test of choice

previous GD = asap after booking + at 24-28wks

any other risk factor = just at 24-28wks

Question 2

diagnostic threshold for gestational diabetes

Answer 2

fasting glucose >= 5.6

2-hr glucose >=7.8

can be dignosed by just ONE higher value, doesnt need to be both i.e 5.8 + 7.6

Question 3

if fasting plasma glucose is <7 at diagnosis, management?

Answer 3

trial of diet + exercise
- if gluc target not met within 1-2weeks –> start metformin

-> if still not met -> start insulin

Question 4

managment of pre-existing diabetes

Answer 4

• BMI >27 = weightloss
• STOP oral hypoglycaemic, except metformin + commence insulin
• folic acid 5mg from preconception to 12wks gestation

treat retinoapthy -> can worsen in pregnancy

Question 5

type of insulin used in gestational diabetes

Answer 5

short-acting

Question 5

if fasting glucose >=7 at time of diagnosis, management?

Answer 5

start insulin

if between 6-6.9 but evidence of cx such as macrosomia or hydramnios = offer insulin

Question 6

targets for self monitoring of pregnant women (pre-existing + gestational diabetes)

Answer 6

fasting = 5.3

1hr after meals = 7.8

2hrs after meals = 6.4

Question 7

how often should pregnant women with type 1 diabetes test her blood glucose?

Answer 7

daily
- fasting
- pre-meal
- 1hour post meal
- bedtime