DR Medhat MRCP

6. Postnatal adaptation problems (e.g hypogly.)
Risk factors for developing gestational diabetes
1. Previous gestational diabetes.
2. Obesity : BMI of > 30 kg/m 2
3. First-degree relative with DM.
4. Ethnic origin with high prevalence of DM (South Asian, Caribbean & MiddleEastern)
5. Previous macrosomic baby weighing ≥ 4.5 kg .
Screening for gestational diabetes
1) All pregnant women→ fasting suger, random bl.sugar ,OGTT & urine R/M (no HbA1C)
2) Pregnant ♀ with GDM → OGTT at 16-18 weeks→ if normal→ repeat at 28 wks
→ detailed anomaly scan at 18-20 wks (4 chambers view of ht)
3) In pregnant woman with any of the other risk factors → OGTT at 24–28 weeks.
Management NICE guidelines 2008):
A. Pre-conceptional care (women with DM who is planning to get pregnant)
Meticulous glycemic control pre & during pregnancy→↓ maternal &fetal risks.
Folic acid 5mg till 12 weeks of gestation.
B. Antenatal care (during pregnancy):
Low glycemic diet &
daily muscular exercise X30 min.
1st line TTT in all cases except in :
o Past H/O macrosomic baby
80-90 % of patients respond will.
Metformin & /or glibenclamide
2 nd line TTT if glycemic control(i.e fasting
glucose 3.5-5.9 & 1hr PP < 7.8) is not
achieved within 1-2 weeks of diet.
1 st line TTT if past H/O macrosomic baby.
Insulin
- Isophan is the 1 st choice
- Lantus is 2 nd choice.
- Lispro & aspart are safe
Start if poor glycemic control with oral ttt.
Advise for the risk of unawared
hypoglycemia
C. During labour : hourly checking bl.sugar, insulin sliding scale, keep level 4-7 mmol/l.