1 / 18

Dr Paul Conaghan GESTATIONAL DIABETES FORUM

Dr. Paul Conaghan, a staff specialist in Obstetrics and Gynaecology at Mater Mothers' Hospital, discusses the management of gestational diabetes (GDM) in this informative forum. Highlighting the risks associated with GDM, including the potential for large babies and related complications, Dr. Conaghan emphasizes the importance of early screening and effective treatment. He reviews findings from the ACHOIS study and outlines key strategies for monitoring and managing pregnancies affected by GDM, ensuring better outcomes for mothers and infants.

jamese
Télécharger la présentation

Dr Paul Conaghan GESTATIONAL DIABETES FORUM

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dr Paul Conaghan GESTATIONAL DIABETES FORUM

  2. Obstetric Management Dr Paul Conaghan Staff Specialist - O&G Mater Mothers Hospital Private Practice - Eve Health paul@evehealth.com.au

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

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

  5. 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 . . . .

  6. Treating GDM works

  7. 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

  8. 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 -

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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!!

More Related