Dr Paul ConaghanGESTATIONAL DIABETES FORUM

Obstetric ManagementDr Paul

ConaghanStaff Specialist - O&G

Mater Mothers Hospital

Private Practice - Eve Healthpaul@evehealth.com.au

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 7.8-11.1mmol/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 26-28 weeks

• High risk– Do GTT at booking and rpt at 26-28

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!!