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Pregnancy in women who already have diabetes treated with insulin

Gestational Diabetes

Gestational diabetes is defined by the World Health Organization (WHO) as‘carbohydrate intolerance resulting in hyperglycaemia of variable severity with onsetor first recognition during pregnancy’. Gestational diabetes mellitus (GDM) is knownto be associated with maternal and foetal complications.

Screening for GDM:

  1. The women with prior history of gestational diabetes: A 2 hour oral glucose tolerance test (OGTT) with 75 gm glucose is booked at 16–18 weeks, followed by the same OGTT at 26-28 weeks if the first test is normal.

  2. The following high risk group of women should be screened for GDM by 2-hour OGTT with 75 G glucose at 26-28 weeks of gestation:

a) Women with previous baby weighing ≥ 4.5 Kg
b) Women with BMI ≥ 35
c) Family history of diabetes (First degree relative with diabetes)

The OGTT results are evaluated against the International Association of Diabetes andPregnancy Study Groups (IADPSG) criteria.

Diagnosis of GDM:

Diagnosis of GDM will be based on the 2hr OGTT results evaluated against theInternational Association of Diabetes and Pregnancy Study Groups (IADPSG)criteria.
The following table shows comparison of IADPSG criteria for diagnosis of GDM.

 

LADPSG

Fasting Plasma Glucose

>5.1 mmol/L

1 hour glucose

≥10 mmol/L

2 hour glucose

≥8.5 mmol/L

Antenatal care for women with GDM

• Referral to joint diabetic ANC at earliest opportunity
• Review by Diabetes Specialist Midwife
• Review by Obstetric and Diabetic team