Gestational_Diabetes_Flashcards
What percentage of pregnancies are complicated by diabetes mellitus?
Up to 1 in 20 pregnancies.
What are the types of diabetes in pregnancy and their prevalence?
87.5% have gestational diabetes, 7.5% have type 1 diabetes, 5% have type 2 diabetes.
How common is gestational diabetes in pregnancies?
Affects around 4% of pregnancies.
What are the risk factors for gestational diabetes?
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, and Middle Eastern).
What is the test of choice for screening gestational diabetes?
The oral glucose tolerance test (OGTT).
When should OGTT be performed for women who’ve previously had gestational diabetes?
As soon as possible after booking and at 24-28 weeks if the first test is normal.
When should OGTT be offered to women with other risk factors?
At 24-28 weeks.
What are the diagnostic thresholds for gestational diabetes according to NICE?
Fasting glucose is >= 5.6 mmol/L, 2-hour glucose is >= 7.8 mmol/L.
What should be done for newly diagnosed women with gestational diabetes?
Seen in a joint diabetes and antenatal clinic within a week, taught about self-monitoring of blood glucose, given advice about diet and exercise.
What is the management if fasting plasma glucose level is < 7 mmol/L?
A trial of diet and exercise should be offered. If glucose targets are not met within 1-2 weeks, metformin should be started. If glucose targets are still not met, insulin should be added.
What is the management if fasting glucose level is >= 7 mmol/L?
Insulin should be started.
What should be done if plasma glucose level is between 6-6.9 mmol/L with complications?
Insulin should be offered.
When should glibenclamide be offered?
For women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment.
What is the management of pre-existing diabetes in pregnancy?
Weight loss for women with BMI of > 27 kg/m², stop oral hypoglycaemic agents apart from metformin, commence insulin, folic acid 5 mg/day from pre-conception to 12 weeks gestation, detailed anomaly scan at 20 weeks, tight glycaemic control, treat retinopathy.
What are the targets for self-monitoring of pregnant women with diabetes?
Fasting: 5.3 mmol/L, 1 hour after meals: 7.8 mmol/L, 2 hours after meals: 6.4 mmol/L.