Gestational but was not diagnosed. In the majority of

Gestational
Diabetes Mellitus (GDM) is a condition that occurs during pregnancy, usually
during the second or third trimester. In most women, it occurs because they
cannot produce enough insulin to meet the extra demands of pregnancy. In others
it may be identified during the first trimester screening, in which case
diabetes most likely existed before the pregnancy, but was not diagnosed.

In
the majority of cases, GDM is identified during the second trimester of
pregnancy. The foetus’s major organs are fairly well developed at this stage
and the risk to the baby is lower than for women with Type 1 or Type 2 diabetes
in whom the pre-existing diabetes can affect the growth of vital organs in the
first trimester. The degree of risk depends on how long blood glucose levels
have been high and on how high the levels have been.

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According
to NICE1, approximately
700,000 women give birth in England and Wales each year.  Of these, up to 5% of these women have either
pre?existing diabetes or gestational diabetes. It is estimated that
approximately 87.5% of these women have gestational diabetes (which might
persist after pregnancy), 7.5% have type 1 diabetes and the remaining 5%
have type 2 diabetes. The incidence of gestational diabetes is increasing
as a result of higher rates of obesity in the general population and more
pregnancies in older women.

 

The
various risk factors identified for developing GDM were:

 

Having a BMI above
30.

previous
macrosomic baby (weighing 4.5 kg or above)
previous GDM
family history of
diabetes (first?degree relative with diabetes)
minority ethnic
family origin with a high prevalence of diabetes (ex- South Asians, Afro-Caribbeans).

 

These
people with increased risks should be monitored closely & offered screening
for GDM routinely, which is provided by the midwives in our area.

Once
diagnosed with GDM, their intra-partum care is provided jointly by the
obstetric team & endocrinologists in our local hospital.

 

In
the post-partum period, once they are discharged back to primary care, we tend
to follow them up with our in-house diabetic team.

 

NICE
guidelines recommend the following for post-partum care1:

 

Offer lifestyle advice including
weight control, diet and exercise.

 

Offer a fasting plasma glucose test
6–13 weeks after the birth to exclude diabetes

 

If a fasting plasma glucose test
has not been performed by 13 weeks, offer a fasting plasma glucose
test, or an HbA1c test if a fasting plasma glucose test is not possible,
after 13 weeks.

 

Offer an annual HbA1c test to women
who were diagnosed with gestational diabetes who have a negative postnatal
test for diabetes. This was new in the 2015 NICE guidelines.