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Gestational Diabetes

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Gestational Diabetes


Aetiology

  • anti-insulin substances secreted by placenta
    • human placental lactogen (hPL)
    • progesterone
    • human chorionic gonadotrophin (hCG)
    • cortisol

Foetal Complications

  • Hyperglycaemia at conception → major foetal abnormalities
    • neural tube defects
    • cardiac abnormalities
    • skeletal abnormalities
    • increased risk of miscarriage
  • foetal hyperinsulinaemia
    • macrosomia
    • polycythaemia
    • impaired lung maturation
    • neonatal hypoglycaemia
    • jaundice
    • hypocalcaemia
    • hypomagnesaemia
  • childhood glucose intolerance
  • prone to adult obesity

Maternal Complications

Risk Factors

  • previous history
  • intra-uterine death late in pregnancy
  • Family Hx of diabetes
  • ethnic group at risk of type II diabetes
  • older than 30 years
  • persistent glycosuria
  • foetal macrosomia

Management

Pre-pregnancy

  • advice on meticulous control
  • folic acid
  • assess for complications
    • diabetic retinopathy
    • diabetic nephropathy
  • change oral hypoglycaemics to insulin

Pregnancy

  • euglycaemia maintained throughout
  • USS for
    • 18-20 weeks accurate dating and detection of abnormalities
    • 34 weeks for foetal growth
  • assessment of foetal well-being
  • optimal time for delivery in relation to complications
  • delivery in hospital

Timing of Delivery

  • full term if well controlled
  • by 38 weeks if Polyhydramnios or foetal macrosomia

Management of labour

Newborn Baby

  • prevent neonatal hypoglycaemia by breastfeeding or oral glucose within 1hour delivery
  • glucose levels should be monitored for 2 days
    • persistent hypoglycaemia may require iv glucose / NG feeding
  • if poorly controlled diabetes then

Follow up

  • 50% gestational diabetes develop overt diabetes mellitus type II
  • monitor yearly if impaired GTT or 2 yearly if normal GTT
  • pre-pregnancy blood glucose
 

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