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Dr Paul Conaghan GESTATIONAL DIABETES FORUM

Dr Paul Conaghan GESTATIONAL DIABETES FORUM . Obstetric Management. Dr Paul Conaghan Staff Specialist - O&G Mater Mothers Hospital Private Practice - Eve Health paul@evehealth.com.au. Obstetric Management. What are we worried about? What benefit do we get?

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Dr Paul Conaghan GESTATIONAL DIABETES FORUM

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  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!!

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