Gestational diabetes (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. GDM is still diagnosed using an oral glucose tolerance test (OGTT) and this is essentially the only situation now when an OGTT should be performed in primary care. The diagnostic criteria are different to that for standard diabetes: fasting glucose \u2265 5.3 mmol\/l and\/or 2hr glucose \u22659.0 mmol\/l. Women with risk factors for GDM, e.g. family history of type 2 diabetes, high risk ethnic group, previous large baby, elevated BMI, will have an OGTT arranged by their community midwife at 24-28 weeks. Women with confirmed GDM will be referred into the diabetes ante-natal service by the community midwife.<\/p>\n\n\n\n
Gestational diabetes occurs in 4-5% of pregnancies, and many women who develop gestational diabetes return to normoglycaemia after the birth of their baby. However there is a high risk of future type 2 diabetes, as high as 50%. Therefore it is essential that they are offered a 12 week HbA1c* AND that they remain on the at risk register for type 2 diabetes.<\/p>\n\n\n\n
*(12 week HbA1c is preferable to a 6 week fasting glucose, particularly in breastfeeding women)<\/p>\n\n\n\n
Post-natal screening<\/strong><\/p>\n\n\n\n Current established practice for Lothian patients is a 12 week HbA1c :<\/p>\n\n\n\n The MCN would recommend that to ensure ongoing annual HbA1c that practices code as both:<\/strong><\/p>\n\n\n\n Gestational diabetes <\/strong>L1809<\/em><\/strong><\/p>\n\n\n\n and<\/p>\n\n\n\n High risk of diabetes annual review** 66A<\/em>z<\/strong><\/p>\n\n\n\n Risk of progression to T2DM<\/strong><\/p>\n\n\n\n Around half of women affected by gestational diabetes go on to progress to T2DM without intervention. They will be offered a wellbeing review from the Dietitian post-partum, and type 2 diabetes prevention education will be discussed and offered. The patients can engage in education but remain welcome at LPD courses at any point in the future.. Healthy diet and an active lifestyle (including better sleep and stress management) with the goal of weight loss or maintaining a healthy BMI are the main focus of reducing this risk, see pre-diabetes<Pre-Diabetes \u2013 RefHelp<\/a>> section for more detail.<\/p>\n\n\n\n Subsequent Pregnancy<\/strong><\/p>\n\n\n\n There is an increased risk of having gestational diabetes in any subsequent pregnancies so women are advised to seek medical advice before planning another pregnancy. Good overall health in the pre-conception period is vital. See Recommendations | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE<\/a><\/p>\n\n\n\n Those with GDM who have accepted postnatal wellbeing review from a Dietitian are offered diabetes prevention education as part of the Lothian GDM Pathway. <\/p>\n\n\n\n There may be people with a history of previous GDM some years ago, direct referrals to the type 2 diabetes prevention programme are welcomed at any time<\/strong> from this cohort<\/p>\n\n\n\n via SCI gateway (WGH\/RIE\/SJH > Diabetes)<\/p>\n<\/div><\/div>\n\n\n\n See Pre-Diabetes \u2013 RefHelp (nhslothian.scot)<\/a> page for approach<\/p>\n\n\n\n Consider also referral to the gestational diabetes specific arm of the app My Desmond (Babysteps) <\/strong>Platform via weight management referral. MyDesmond | Prevent or Manage Type 2 Diabetes<\/a><\/p>\n<\/div><\/div>\n\n\n\n Lets Prevent Diabetes \u2013 Adult Weight Management and Type 2 Diabetes Prevention Service (nhslothian.scot)<\/a><\/p>\n\n\n\n My Diabetes My Way eLearning (scot.nhs.uk)<\/a><\/p>\n\n\n\n Gestational diabetes | Causes and symptoms | Diabetes UK<\/a><\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":" Gestational diabetes (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. GDM is still diagnosed using an oral glucose tolerance test (OGTT) and this is essentially the only situation now when an OGTT should be performed in primary care. The diagnostic criteria are different to that for standard<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3854,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1231],"class_list":["post-23032","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-gestational-diabetes"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" Gestational Diabetes<\/a>","rttpg_excerpt":"Gestational diabetes (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. GDM is still diagnosed using an oral glucose tolerance test (OGTT) and this is essentially the only situation now when an OGTT should be performed in primary care. 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<\/ul>\n
Who to refer:<\/strong><\/h4>\n\n\n\n
How to refer:<\/strong><\/h4>\n\n\n\n