Gestational Diabetes
Definition
Any glucose intolerance with first diagnosis during pregnancy and resolving post partum
Epidemiology
Around 24-28/40
Risk Factors
Aetiology
· Anti-insulin factors produced by placenta and high maternal cortisol levels create increased peripheral insulin resistance > leading to GDM and/or exacerbating pre-existing DM
Pathogenesis
Pregnancy --> Hormones (eg human placenta lactogen (hPL), hCG, progesterone, cortisol, TNF a) --> anti insulin action --> mo b islet cells unable to produce more insulin --> GDM
Screening + Diagnosis
Management
Source
Llewellyn-Jones 9th Ed 2010
http://www.racgp.org.au/afp/2013/august/gestational-diabetes-mellitus/
Any glucose intolerance with first diagnosis during pregnancy and resolving post partum
Epidemiology
Around 24-28/40
Risk Factors
- Previous GDM
- Previously elevated blood glucose level
- Ethnicity: south and southeast Asian, Aboriginal, Pacific Islander, Maori, Middle Eastern, non-Caucasian African
- Age ≥40 years
- Family history of diabetes mellitus (first degree relative with diabetes mellitus or a sister with GDM)
- Obesity, especially BMI >35 kg/m2
- Previous macrosomia (baby with birth weight >4 500 g or >90th percentile)
- Polycystic ovarian syndrome
- Medications: corticosteroids, antipsychotics
Aetiology
· Anti-insulin factors produced by placenta and high maternal cortisol levels create increased peripheral insulin resistance > leading to GDM and/or exacerbating pre-existing DM
Pathogenesis
Pregnancy --> Hormones (eg human placenta lactogen (hPL), hCG, progesterone, cortisol, TNF a) --> anti insulin action --> mo b islet cells unable to produce more insulin --> GDM
Screening + Diagnosis
- OGTT before pregnancy (with risk factors) and @ 24-28/40 (others)
- Fasting >/= 5.1
- 1h >/= 10
- 2h >/= 8.5
Management
- Lifestyle changes
- Metformin/ Gilbenclamide (not approved for GDM use in Aust), Insulin
- Aim fast </= 5; 1h post meal</=7.4; 2h post meal </=6.7
- Postpartum: breastfeed, measure 6-12w post (inc risk of DM), then yearly
Source
Llewellyn-Jones 9th Ed 2010
http://www.racgp.org.au/afp/2013/august/gestational-diabetes-mellitus/