Gestational diabetes Flashcards
(17 cards)
What is gestational diabetes?
Diabetes triggered by pregnancy which is caused by reduced insulin sensitivity during pregnancy & resolves after birth.
What is the most significant complication of gestational diabetes?
Large for dates fetus & macrosomia which has implications for birth - shoulder dystocia.
What do you do with women with risk factors?
Screen with an oral glucose tolerance test at 24-28 weeks gestation.
What are the risk factors for gestational diabetes?
- Previous gestational diabetes
- previous macrosomic baby (4.5kg)
- BMI > 30
- ethnic origin
- family history of diabetes
- unexplained still birth in a previous pregnancy.
Explain the test of OGTT?
Perform it in the morning after a fast (pt can drink plain water) where patient drinks 75g glucose drink. Blood sugar is measured before the sugar drink (fasting) and then after 2 hours.
What are the normal results of a fasting glucose testing?
- Fasting < 5.6mmol/l
- At 2 hours < 7.8 mmol/l (5,6,7,8 rul
- Anything higher = gestational diabetes.
How is gestational diabetes generally managed?
Joint diabetes & antenatal clinic with input from a dietician. Explain condition with info on how to track & monitor their blood sugar. 4 weekly USS scans to monitor fetal growth from 28-36 weeks gestation.
What is the initial management for gestational diabetes?
- Fasting glucose less than 7mmol/l = trial of diet & exercise for 1-2 weeks → metformin → insulin.
- Fasting glucose above 7mmol/l = insulin & metformin.
- Fasting glucose above 6mmol/l plus macrosomia = insulin (no matter what) & metformin.
What sulfonylurea can be used for women who decline insulin or can’t tolerate metformin?
Glibenclamide.
If a woman has existing diabetes, what should they aim for and what supplements should they take?
Good glucose control and 5mg folic acid from preconception until 12 weeks gestation.
If a woman has existing type 2 diabetes, what should they do?
Metformin & insulin. Stop all other oral diabetic meds.
What is considered during labour for women with type 1 diabetes?
A sliding scale insulin regime. A dextrose and insulin infusion is titrated to blood sugar levels. This is also considered for women with poorly controlled blood sugar levels with gestational or type 2 diabetes.
What screening is performed and when?
Retinopathy screening shortly after booking and at 28 weeks gestation to check for diabetic retinopathy.
What is advised regarding birth for women with diabetes?
Planned delivery between 37 and 38 + 6 weeks for women with pre-existing diabetes. Gestational diabetes = 40 + 6.
What is done regarding medication after birth?
- Gestational diabetes = stop diabetic meds immediately after birth but follow up with fasting glucose after 6 weeks.
- Existing diabetes = lower insulin doses and be mindful of hypoglycaemia in postpartum period as insulin sensitivity increases after birth & with breastfeeding.
What are babies of mothers with diabetes at risk of?
Neonatal hypoglycaemia, polycythaemia, jaundice (raised bilirubin), congenital heart disease, cardiomyopathy.
If a baby’s blood sugar is below 2mmol/l, what do they need?
Neonatal hypoglycaemia. Babies become accustomed to a large supply of glucose during the pregnancy and after birth they struggle to maintain the supply they are used to with oral feeding alone. IV dextrose of nasogastric feeding.
