GDM diagnosis Report released from RANZCOG have endorsed new diagnostic criteria – 2 weeks ago July 2014 – 28/40 universal OGTT Cease to offer 50g GCT To be adopted no later than 01.01.2015 RANZCOG – Michael Permezel - President
Diabetes Education Following diagnosis -> education is vital Optimal -> within 1/52 of diagnosis Reduce maternal anxiety Correct information – up to date Encourage partner or support person to attend Challenge of working within a limited timeframe
Key Components of Education Overview of Gestational Diabetes Implications for mother and baby Home blood glucose monitoring (HBGM) or (SBGM) Review by Dietitian NDSS – National Diabetes supplies scheme Obstetric assessment Medical assessment
DVD – Diabetes Australia Brochures/Pamphlets Demonstration Useful websites eg ADIPS, DA, ADEA, You2 connect Must be culturally appropriate. Education Tools
Blood glucose monitoring Arrange use of meter – free of charge scheme Demonstrate use of meter Lancet / finger pricking device Record book Disposal of sharps Sites for performing tests Timing of tests – ie QID -Before breakfast & 1 or 2 hrs after each main meal – refer to local protocols
Recognised as important adjunct therapy Appropriate for pregnancy Eg walking, swimming, pregnastic, water aerobics Recommended in absence of obstetric & medical complications Culturally appropriate Physical Activity
Insulin Therapy Decision made by treating doctor Based on BSL’s, gestation and clinical evidence eg SGA or LGA baby Individual education session Dose Device Injection Sites Injection Technique Timing of injections Disposal of sharps Management of hypo’s
Metformin Studies conducted in Aust and NZ to assess safety and efficacy of use during pregnancy MiG study Follow up studies on offspring Increased usage since MiG study
Insulin & Metformin Translations ArabicPunjabi BengaliSimple Chinese FarsiTamil FilipinoThai HinduTraditional Chinese JubaTurkish Vietnamese
Vital GTT – 6 - 8 weeks postnatally Follow up by dietitian Follow up by midwife Discuss – lifestyle issues, weight management, diet, exercise, future pregnancy, contraception Annual fasting glucose with GP Post natal follow up
Alerts Need to look at the whole picture Sometimes clinical scenario doesn’t match GDM What to consider BGL – good glycaemic control Self reported dietary modifications and increased physical activity Clinically LGA Significant maternal weight gain USS – fetal macrosomia
Normal pathway now altered Heightened anxiety and stress at diagnosis Impedes ability to learn Guilt Concern for baby Potential separation from baby at birth Will my baby have diabetes? Psychosocial Issues
Management Full explanation of GDM Implications for pregnancy Regular contact with specialist team Ensure plan for birth in partnership with woman Education – management of diabetes during delivery and postpartum Routine care during labour Monitor BGL’s – local protocols Anticipate shoulder dystocia Notify Paediatricians. Neonatal hypoglycaemia – test @ 1,2 & 4 hours.
Useful websites ADIPS – Australasian Diabetes in Pregnancy Society www.adips.org Diabetes Australia www.diabetesaustralia.com.au You2 Connect www.You2.org.au
Conclusion When a pregnancy is complicated by diabetes a multidisciplinary team approach provides the best care for a mother and her baby to achieve an optimal outcome.