Guidelines & References
Queensland Clinical Guidelines: Gestational diabetes mellitus (GDM) - MNT p24 |
What is it?
Glucose intolerance that is first diagnosed or recognised during pregnancy and does not meet criteria for diabetes outside of pregnancy |
Diagnosis
Screening @ ~25 weeks – 75g OGTT (or in first trimester if risk factors) |
GDM IF ONE OF: |
OGTT Fasting >5.1 |
OGTT 1 hour post >10 |
OGTT 2 hour >8.5 or |
HbA1C (first sem) >4.1 |
S/S
Most don’t experience S/S - 3 Ps, nausea, glucosuria |
Risk factors
Ethnicity (Asian, Indian subcontinent, Aboriginal, Torres Strait Islander, Pacific Islander, Māori, Middle Eastern) |
Previous GDM or elevated blood glucose levels |
Maternal age 40+ |
BMI > 30 kg/m² pre-conception |
Hx: Birth weight > 4500 g or > 90th centile, preterm birth |
Medication - Corticosteroids & Antipsychotics |
Family hx DM |
Multiple pregnancy |
PCOS |
Hypothyroidism |
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Consequences
Mother |
Newborn |
Pre-eclampsia (↑ BP, protein in urine, organ dysfunction) (short term) |
Prematurity, esp. if maternal hyperglycaemia severe and required insulin treatment (short term) |
Induced labour (short term) |
Respiratory distress syndrome (short term) |
Hypertension in labour (short term) |
Cardiac anomalies (short term) |
C-section (short term) |
Impaired glucose tolerance (long term) |
Progression to T2DM (long term) |
Development of T2DM (long term) |
Renal disease (long term) |
Overweight and obesity (long term) |
Intervention
Medication: Metformin or Insulin |
Food: Low GI, with minimum of 175g CHO/day, ↑ fibre |
General healthy eating - balanced meals |
Edu: CHO, GI, safe foods for pregnancy, label reading, eating enough, weight loss NOT recommended, healthy weight gain |
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Monitoring
BGL |
Review every 2-3 weeks. 1 postnatal follow-up |
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