 |
Diabetes mellitus
Gestational diabetes
|
Principle: All pregnant women to be screened for gestational diabetes.
Those with gestational diabetes will be offered specialist input to optimise
maternal / foetal / obstetric outcomes
Key points
- Gestational diabetes is associated with an increase in maternal, foetal
and obstetric problems. Women with gestational diabetes are also at
increased risk of developing diabetes / hypertension and CHD in later life.
- All pregnant women should be screened for gestational diabetes as part of
their routine antenatal care. The protocol no longer includes special
instructions for high-risk groups or those with previous gestational
diabetes, as everyone is now screened
Screening
- Urine testing should be performed monthly at each clinic visit to identify
glycosuria. Those with persisting glycosuria (1+ or more) should have blood
taken for a random timed (lab) blood glucose
- Blood should be taken for a random timed (lab) glucose at booking and 28
weeks*
- If glycosuria persists and timed blood glucose results fall within the
normal range, please perform an additional random timed blood glucose at:
18-20 weeks
The time of the last intake of food or drink and the sample time must be
recorded on the form.
Results
A blood glucose >11mmol/l is diagnostic of diabtes - refer to diabetic
services urgently (same day). No need for OGTT.
Proceed to urgent 75g OGTT if timed lab glucose
- >6.0mmol/l fasting
- >6.4mmol/l 2hrs after a meal
- >7.0mmol/l within 2 hours of food
Results of OGTT
| |
2-hour reading |
| Gestational diabetes |
>7.8 |
| Normal |
<7.8 |
Management
Women with gestational diabetes should be:
- Offered dietary advice (low fat higher complex carbohydrate)
- Encouraged to perform upper body exercises
- Taught to monitor blood sugars
Gestational diabetes key targets
- BM 4-6 fasting
- BM <8 two hours after meals
- HbAlc <6.5%
The above is usually achieved by a combination of dietary changes and Insulin
use
All women with gestational diabetes should
have a repeat OGTT (oral glucose tolerance test) 8 weeks post delivery to
identify those with underlying IGT or Diabetes.
Source: Northumbria NHS Health Care Trust diabetes protocol