Gestational Diabetes Mellitus (GDM)

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Questions and Answers

Which committee endorses the Queensland Clinical Guidelines?

Clinical Excellence Queensland

Queensland Health

Queensland Clinical Guidelines Steering Committee (correct)

Statewide Maternity and Neonatal Clinical Network

Which of the following is a risk factor for gestational diabetes mellitus (GDM)?

Previous GDM

Previous macrosomia (correct)

Previous perinatal loss

Previous elevated BGL

Which test is used to screen and diagnose GDM during the first trimester?

Fasting BGL

OGTT

HbA1c (correct)

Postprandial capillary BGL self-monitoring

Which ethnicities are considered as risk factors for GDM?

Asian, Indian subcontinent, Aboriginal, Torres Strait Islander, Pacific Islander, Maori, Middle Eastern, non-white African Signup and view all the answers

What is the suggested fasting target for capillary blood glucose levels in GDM management?

< 5 mmol/L Signup and view all the answers

When should an oral glucose tolerance test (OGTT) be performed during pregnancy?

First trimester Signup and view all the answers

What is the diagnostic criteria for GDM based on fasting blood glucose level (BGL) during an OGTT?

≥ 5.1 mmol/L Signup and view all the answers

What is the BMI threshold for being considered a risk factor for GDM?

<blockquote> 30 kg/m2 </blockquote> Signup and view all the answers

What is the purpose of postprandial capillary blood glucose level self-monitoring in GDM management?

To monitor blood glucose levels after meals Signup and view all the answers

What is the recommended action if there is clinical suspicion of diabetes during the third trimester of pregnancy?

Repeat testing Signup and view all the answers

According to the Queensland Clinical Guideline, what is the recommended mode of birth for women with gestational diabetes mellitus (GDM) requiring metformin and/or insulin?

Vaginal (spontaneous or IOL) Signup and view all the answers

When should metformin be ceased for women with GDM requiring metformin and/or insulin before a procedure?

After evening dose prior to procedure Signup and view all the answers

What should be done if a woman with GDM requiring insulin is scheduled for a morning induction of labour (IOL) and labour is not yet established?

Eat breakfast and give usual rapid acting insulin Signup and view all the answers

What should be done if a woman with GDM requiring insulin is scheduled for an afternoon induction of labour (IOL) and labour is not yet established?

Give usual mealtime and bedtime insulin Signup and view all the answers

What should be done if a woman with GDM requiring insulin is on an IV insulin infusion and labour is not yet established?

Consult with an anaesthetist Signup and view all the answers

What should be done if a woman with GDM has a blood glucose level (BGL) between 4.0─7.0 mmol/L during intrapartum management?

Repeat BGL in 1 hour and reassess requirements Signup and view all the answers

What should be done if a woman with GDM has a BGL < 4.0 mmol/L during intrapartum management?

Treat hypoglycaemia and repeat BGL in 15 minutes Signup and view all the answers

When should metformin and/or insulin be ceased for women with GDM after birth?

Immediately after birth (vaginal or CS) Signup and view all the answers

How often should blood glucose levels (BGL) be monitored for women with GDM in the postpartum period?

4 times per day for 24 hours after birth Signup and view all the answers

What is the recommended postpartum care for women with GDM?

All routine care as indicated Signup and view all the answers

Study Notes

Queensland Clinical Guidelines Endorsement

The Queensland Clinical Guidelines are endorsed by the Queensland Clinical Guidelines Steering Committee.

Risk Factors for Gestational Diabetes Mellitus (GDM)

Major risk factors for GDM include obesity, advanced age, family history of diabetes, and certain ethnic backgrounds.
Ethnicities with increased risk for GDM include Indigenous Australians, Torres Strait Islanders, some Asian populations, Pacific Islanders, and Middle Eastern descent.

Screening and Diagnosis of GDM

A standard test used for screening and diagnosing GDM during the first trimester is the Oral Glucose Tolerance Test (OGTT).
Fasting target for capillary blood glucose levels in GDM management is typically ≤5.0 mmol/L.

Timing of Testing

An OGTT should be performed between 24 and 28 weeks of pregnancy.
Diagnostic criteria for GDM include a fasting blood glucose level of ≥5.1 mmol/L during an OGTT.

Body Mass Index (BMI) and GDM

A BMI of ≥30 kg/m² is considered a risk factor for developing GDM.

Monitoring in GDM Management

Postprandial capillary blood glucose level self-monitoring helps in managing GDM by managing glycemic control after meals.
If diabetes is suspected in the third trimester, further testing and monitoring should be conducted.

Birth Recommendations

For women with GDM requiring metformin and/or insulin, the recommended mode of birth is vaginal unless medical indications suggest otherwise.

Medication Management Before Procedures

Metformin should be ceased at least 24 hours before any procedure requiring anesthetic or where fasting is necessary.

Induction of Labour (IOL) Guidance

For morning IOL with GDM requiring insulin, if labor is not established, administer short-acting insulin as needed based on blood glucose levels.
For afternoon IOL, continue normal insulin regimen unless instructed otherwise by healthcare providers.
If a woman is on an IV insulin infusion and labor is not established, infusion rates should be adjusted based on continuous glucose monitoring.

Intrapatum Management

If a woman with GDM has a blood glucose level (BGL) between 4.0–7.0 mmol/L during intrapartum management, routine monitoring should continue.
If the BGL is <4.0 mmol/L, treatment should be initiated to raise glucose levels, typically through oral glucose or IV dextrose.

Postpartum Management

Metformin and/or insulin should be ceased for women with GDM immediately after the birth of the placenta.
In the postpartum period, blood glucose levels should be monitored 1–2 times weekly for women with a history of GDM.
Recommended postpartum care includes assessment of glucose levels and education regarding diabetes management and lifestyle modifications.

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Description

Test your knowledge on Gestational Diabetes Mellitus (GDM) with this quiz. Learn about the clinical guidelines and best practices for managing GDM in Queensland Health.