Dr Paul ConaghanGESTATIONAL DIABETES FORUM

Obstetric Management

Dr Paul Conaghan

Staff Specialist - O&GMater 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!!