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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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