Flashcards in Diabetes in pregnancy Deck (25)
If a woman has preexisting type 1 or type 2 diabetes at the commencement of care, what is the responsibility of the midwife with regard to consultation and referral?
If a woman at the commencement of care presents with a history of gestational diabetes in a previous pregnancy, what is the responsibility of the midwife with regard to consultation and referral?
If a woman develops gestational diabetes during pregnancy what is the responsibility of the midwife with regard to consultation and referral: if it is diet controlled? if she requires insulin?
if diet controlled - B consult
if requiring insulin - C refer
If a woman has a BMI 35 at the commencement of care, what is the responsibility of the midwife with regard to consultation and referral?
If a woman has a BMI >40 at the commencement of care, what is the responsibility of the midwife with regard to consultation and referral?
What is gestational diabetes?
any degree of glucose intolerance with onset or first recognition in pregnancy
What is the incidence of gestational diabetes?
GDM affects 8-10% of pregnancies in australia
When is GDM usually tested for?
routinely at 24-28 weeks gestation
early for high risk women at 12-16 weeks
at 6-8 weeks postpartum in women diagnosed with gestational diabetes
What are the risk factors for GDM?
- previous GDM
- previous stillbirth/FDIU
- ethnicity (indigenous australian, pacific islander, indian, SE Asian, middle eastern, maori, afro-carribean
- age > 40
- first degree relative with insulin dependent diabetes
- previous macrosomia (>4500g)
- polycystic ovarian syndrome
- medications (corticosteroids, antipsychotics)
What 4 tests may be used in screening for GDM?
- oral glucose tolerance test (diagnostic)
- non fasting plasma glucose
- HbA1c (not reimbursed by medicare)
Criteria for diagnosis of GDM with a GTT
Fasting glucose >5.1 mmol/L
2h glucose >8 mmol/L
values vary according to local protocols
What is the procedure for a GTT?
- fasting for 10-12 hours
- baseline plasma glucose measured
- 75g glucose drunk within 5 mins
- plasma glucose measured at 1 hour and 2h
- no food, smoking, drinks other than water or exercise during test
What blood glucose levels should be targeted (fasting, 1 hour and 2 hour post meal) in diet controlled GDM?
What strategies are common in managing GDM antenatally?
- modification of diet
- regular exercise
- home blood glucose monitoring
- increased frequency of antenatal visits
- interdisciplinary team (midwife, obstetrician, diabetes educator, dietition, other specialists)
What are the associated risks of gestational diabetes?
- perinatal death
- macrosomia (shoulder dystocia, perineal trauma)
- birth trauma
- neonatal hypoglycaemia, hypocalcaemia, magnesaemia
- respiratory distress syndrome
- neonatal polycythaemia
What long term risks exist for women that have had gestational diabetes?
50% risk of developing type 2 DM within 20 years
What drugs may be used to treat women with gestational diabetes that isn't controlled sufficiently with diet?
- glibenclamide (caution)
What are the postnatal recommendations for women with gestational diabetes?
GTT at 6-12 weeks postpartum
diabetes testing 1-2 yearly
List 5 important considerations providing labour care for women with GDM?
- timing of birth (some facilities induce, c/s at 38-39/40, particularly if macrosomic, persistant hyperglycaemic or other complications)
- glucose levels in labour
- fetal monitoring (? continuous CTG in labour for GDM on insulin, blood glucose outside optimal range or ? macrosomic)
- ? shoulder dystocia
- active management of third stage
List 4 means of assessing fetal wellbeing where mum has GDM?
- fetal movements
- fundal height
- regular CTG if IUGR or macrosomia
What are the three different types of diabetes?
- type 1 insulin deficient
- type 2 insuline resistant
How do the normal physiological changes of pregnancy usually change insulin requirements?
- usually fall in first trimester
- rise in second and third trimesters
- return quickly to prepregnancy after birth
What is the mode of action for metformin?
- reduces insulin resistance
- reduces hepatic glucose production, decreased absorption of glucose and increased peripheral uptake of glucose
How safe is use of metformin in pregnancy?
- important to talk to doctor before considering stopping treatment
- evidence suggests that metformin may increase the chances of conception for women with PCOS, women who continue taking metformin in the first trimester may also have a lower risk of miscarriage, may reduce risk of developing gestational diabetes
- category C - insufficient evidence, no evidence of adverse effects on baby or increased risk of congenital abnormalities
- appears to be safe in breastfeeding women