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Questions and Answers
Which committee endorses the Queensland Clinical Guidelines?
Which of the following is a risk factor for gestational diabetes mellitus (GDM)?
Which test is used to screen and diagnose GDM during the first trimester?
Which ethnicities are considered as risk factors for GDM?
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What is the suggested fasting target for capillary blood glucose levels in GDM management?
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When should an oral glucose tolerance test (OGTT) be performed during pregnancy?
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What is the diagnostic criteria for GDM based on fasting blood glucose level (BGL) during an OGTT?
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What is the BMI threshold for being considered a risk factor for GDM?
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What is the purpose of postprandial capillary blood glucose level self-monitoring in GDM management?
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What is the recommended action if there is clinical suspicion of diabetes during the third trimester of pregnancy?
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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?
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When should metformin be ceased for women with GDM requiring metformin and/or insulin before a procedure?
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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?
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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?
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What should be done if a woman with GDM requiring insulin is on an IV insulin infusion and labour is not yet established?
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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?
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What should be done if a woman with GDM has a BGL < 4.0 mmol/L during intrapartum management?
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When should metformin and/or insulin be ceased for women with GDM after birth?
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How often should blood glucose levels (BGL) be monitored for women with GDM in the postpartum period?
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What is the recommended postpartum care for women with GDM?
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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.
