Dr Paul Conaghan GESTATIONAL DIABETES FORUM

Obstetric Management Dr Paul Conaghan Staff Specialist - O&G Mater Mothers Hospital Private Practice - Eve Health

Obstetric Management What are we worried about? What benefit do we get? What should I watch out for?

What are we worried about? Big babies!!!!!! And the attendant risks thereof.

ACHOIS Take 1000 women with abnormal GTT –Fasting BSL<7.8mmol/L –2hr BSL mmol/L Tell 500 of them – “You’re normal” and continue their routine antenatal care Tell the other half – “You have diabetes” and send them off to multidisciplinary care Compare their outcomes....

Treating GDM works

ACHOIS Those “labelled” as GDM had better scores on questionnaires related to their own general health and wellbeing, both during and 3 months after pregnancy The “labelled” group had much lower scores on the Edinburgh PND scale at 3 months post-partum

Other benefits Reduced risk of –PET (RR0.62) –Birthweight >4kg (RR 0.5) –Shoulder dystocia (RR0.42) I don’t want to harp on HAPO.... but -

What should I do? Everything Karin and Susie and Allison tell you to! Skip the Glucose Challenge Test Think carefully about risk at booking and do some form of screening

Booking in screening Low risk –Random BSL – should be <8 –Do GTT at weeks High risk –Do GTT at booking and rpt at weeks

What should I do? Watch sugars and use treatment targets Monitor fetal growth – reasonable to do at least one scan Make an educated decision about time and mode of birth

Timing and Mode of Birth EFW>4.5kg – consider LSCS –Reduces incidence of shoulder dystocia but NNT is 443 If insulin requiring – electively deliver after 38 weeks –Reduces incidence of macrosomia and shoulder dystocia If well-controlled with a normal size baby –Still consider IOL after 38 weeks

Afterward... GTT at 6 weeks Consider regular GTT - ?with annual health check or with PAP smear? Warn the patient about the risk of Type II DM

What else? Keep your thinking cap on! –AC>>HC in a morbidly obese patient with a strong family history of DM could still be GDM even if the GTT is normal!!