Gestational Diabetes

Physiology
1. Altered carbohydrate metabolism
2. Antagonistic effects of HPL, progesterone and cortisol
3. Induced fetal hyperinsulinaemia
4. Resulting in macrosomia
Investigations
1. Screening at booking if at least one RF:
  1. BMI > 30
  2. Prev Dx
  3. Prev macrocosmic baby 4.5kg
  4. FDR with DM
  5. High risk ethnicity
2. Or detected by routine urinalysis
  1. 2+ on one occasion, or 1+ on two occasions
3. Testing
  1. 2hr 75g OGTT
  2. Offer again at 24-28 weeks if normal
  3. Offer at 24-28 weeks to all other women if one of:
    1. Previous unexplained still birth
    2. Polyhydramnios
4. Diagnosis
  1. Fasting plasma glucose 5.6mmol/l or 2hr 7.8mmol/l
Complications
1. Macrosomia
  1. Trauma during birth
  2. Shoulder dystocia
2. Induction of labour
3. Caesarean Section
4. Neonatal Hypoglycaemia
5. Perinatal death
6. Hypertension in pregnancy
Management
1. Antenatal care
  1. Monitor blood glucose
  2. Target levels
  3. Monitor HbA1c at Dx to identify T2 DM
  4. Monitor fetal abnormalities (esp. cardiac) at 20wk scan
  5. Serial growth scans 4wkly > 28wks
2. Treatment
  1. 1. Lifestyle changes
  2. 2. Metformin (if targets not met by 2wks)
  3. 3. Insulin if metformin unsuitable
  4. Insulin if fasting >7mmol at Dx or lower if complications e.g. macrosomia
  5. Glibenclamide if insulin refused
3. Birth
  1. No later than 40+6 wks
  2. Suggest elective <40+6 if complications e.g. macrosomia

Resource summary

	Created by Anna Todd about 8 years ago