glucose intolerance that is present only during pregnancy genetic predisposition to the development of glucose intolerance exists in this...
- glucose intolerance that is present only during pregnancy
- genetic predisposition to the development of glucose intolerance exists in this population of women
- 50% risk of developing Type II DM in next 20 years
Risk Factors
- age > 30
- previous history of high blood glucose, GDM, or macrosomic infant (> 4.5 kg) p
- ositive family history (GDM, Type II DM, macrosomic infant)
- excessive weight gain in pregnancy, prepregnancy obesity
- baby > 4.5 kg or large for GA
- previous unexplained stillbirth
- previous congenital anomaly
- early preeclampsia or polyhydramnios
- repeated vaginal candidiasis
- member of high risk ethnic group
- multiple gestation
Diagnosis
- screen at 26 weeks (or earlier) with 50 g oral glucose challenge test if risk factors or glycosuria are present
- > 7.8 mmol/L at 1 hour is abnormal
- confirm with 3 hour 100 g oral glucose tolerance test (OGTT)
- need 2 out of 4 values to be abnormal to diagnose GDM
- fasting: > 5.8 mmol/L
- 1 hour: > 10.6 mmol/L
- 2 hour: > 9.2 mmol/L
- 3 hour: > 8.1 mmol/L
Management of Gestational Diabetes
- controversial
- aim to achieve normal blood sugars post-prandial (i.e. < 6.7 mmol/L)
- start with diabetic diet
- if blood sugars 2 hours post-prandial are > 6.7, add insulin
- oral hypoglycemic agents contraindicated in pregnancy
- fetal monitoring and timing of delivery same as for DM above
- insulin and diabetic diet should be stopped post-partum
- follow-up testing recommended postpartum because of increased risk of overt diabetes (i.e. OGTT at 6 weeks postpartum)
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