Pamela Harnden 04002987

Gestational

Diabetes

Women who have developed diabetes

during pregnancy are at greater risk of

type 2 diabetes later in life .

Future implications for your

health

PREGNANCY

INFORMATION SERVICES

Information is

empowerment for all.

Recommendations for future

testing.

If you have had gestational diabetes in

pregnancy you should have a repeat blood

test when your baby is 6wks old and then

have a blood test every 2 years.

Preventative Dietary Advice

Maintain a healthy weight.

Exercise

Consider maintaining healthy fitness.

References

Farrar,D,Duley L,Lawlor, D.A. (2009) Alternative tests for

diagnosing gestational diabetes (protocol) The Cochrane Collabo-

ration Retrieved from the Cochrane library 19/11/09

Diabetes New Zealand

http://www.diabetes.org.nz/about_diabetes/gestatio

nal_diabetes

Reinauer,H. Home, PD, Kanagasabapathy A.S.

(2002) WHO Laboratory Diagnosis and Monitor-

ing of Diabetes Mellitus

Diabetes Action Now

http://www.who.int/diabetes/en/DANbooklette

xt%20ENGLISH.pdf

Definition and diagnosis of diabetes mellitus and inter-

mediate hyperglycaemia Report WHO/IDF con-sultation WHO 2006 http://www.who.int/

diabetes/publications/Definition%20and%

20diagnosis%20of%20diabetes_new.pdf

Khatib OMN,(2006) Guidelines for the preven-

tion and management of diabetes mellitus.

http://whqlibdoc.who.int/

emro/2006/9789290214045_eng.pdf

Alwan N, Tuffnell DJ,West J. (2009) Treatments

for gestational diabetes The Cochrane Collabo-

ration

Pairman, Pincombe, Thorogood, Tracy. (2006)

Midwifery Preparation for Practice. Elsevier

Tieu J, Crowther CA, Middleton P. Dietary ad-

vice in pregnancy for preventing gestational

diabetes mellitus. Cochrane Database of Sys-

tematic Reviews 2008, Issue 2. Art. No.:

CD006674. DOI:

10.1002/14651858.CD006674.pub2.

Who is at risk?

If you circled yes to any of the self assess-

ment questions you could be at a higher

risk of developing gestational diabetes.

Instructions for accurate

testing for 2hr glucose test

Three days unrestricted, carbohydrate

rich diet and activity.

No medication on the day of the test.

12-h fast.

No smoking.

Questions to ask.

Do I have a mild or serious form of gesta-

tional diabetes?

There is almost clinical consensus to treat

severe forms of gestational diabetes. How-

ever, treating the milder forms of gesta-

tional diabetes is more controversial

If I believe I am at low risk of developing

gestational diabetes do I need to be

tested?

Screening during pregnancy can be con-

troversial when pregnancy and birth are

supposed to be kept as a normal life event

which occurs to healthy women.

If you are worried, concerned or

have any questions you should con-

tact your lead Maternity Carer.

Self Assessment Questionnaire

1. Do you have a family history of

type 2 diabetes? (Parents/brothers/

sisters) Yes No

2. Have you had diabetes in a pre-

vious pregnancy? Yes No

3. Have you had a previous baby

with a birth defect?

Yes No

4. Are you very overweight?

Yes No

5. Are you over the age of 30?

Yes No

6. Have you had a stillborn baby

or a spontaneous miscarriage?

Yes No

7. Have you previously had a

baby which weighed more than

9lb? Yes No

8. Have suffered high blood pres-

sure in a previous pregnancy?

Yes No

9. Have you ever suffered from

repeated urinary tract infec-

tions?

Yes No

10. Have you suffered from too

much amniotic fluid in previous

pregnancy?

Yes No

11. Do you come from a Maori,

Asian, Tongan or Samoan Back-

ground? Yes No

GESTATIONAL DIABETES (GDM)

What is gestational diabetes?

Gestational diabetes occurs when a preg-

nant woman has high levels of glucose in

her blood. High blood glucose is caused

because the mother can’t produce enough

insulin (a pregnant woman’s insulin needs

are two to three times that of normal).There

are two reasons why the mother needs more

insulin:

Because pregnancy causes certain types of

hormones (that are made by the placenta) to

be released. These hormones make it

harder for insulin to do its job

Because the growth demands of the foetus

(developing baby) increases the mother's

need for insulin. In most cases women will

have no symptoms of having the condition.

The condition temporarily occurs during

pregnancy and things then return to normal.

What are the effects on mum?

Urinary Tract Infections or High blood pres-

sure

Pre term labour/increased risk of labour

being induced.+ increased fluid around

baby

Caesarean Section

and baby?

High/low birth weight

Perceived increased risk of shoulder be-

coming stuck during birth.

Respiratory distress after birth / Jaundice

Reduced blood flow to the placenta giving

increased risk of stillbirth.

Screening for gestational

diabetes.

1.) High Risk– Fasting blood glucose test

in the 1st trimester

2.) High Risk & average risk—A 2hr glu-

cose test at 24-28wks.

3.) Low risk—1hr glucose test at 24-

28wks

3.) Urine testing at each A/N visit

Fasting blood test in 1st

12wks will detect 40% of

cases

Fast from 12mn and then have a blood

test taken at the lab. Follow that up later

in pregnancy with :-

OGTT –2hr test will detect

31% of cases

(Oral Glucose Tolerance Test). Only test

which can confirm diabetes in preg-

nancy.

Fast from 12MN, visit lab 1st blood test

taken then given 75g Glucose drink and

further blood test taken 2hrs later.

OGTT—1hr test

(Oral Glucose Loading Test)

No fasting visit the lab and drink a 50g

drink of glucose stay at the lab for 1hr

then have blood taken. A test which is

recommended as routine by the Royal

Australian and New Zealand College of

Obstetricians and Gynaecologists.