Objective: Gestational diabetes mellitus occurs in 29 percent of all pregnancies. It is associated with substantial maternal and perinatal complications which can all be reduced if it is diagnosed. In UK 65% of pregnant complicated by diabetes involve gestational diabetes. Professional bodies disagree about whether to recommend routine screening, selective screening or no screening of gestational diabetes. The NICE guidelines are in progress and are expected by end of 2007. We review the diagnosis and management of gestational diabetes in DGH in Wales.
Method: We audited retrospectively all the patients with gestational diabetes who either presented through antenatal clinic or were picked up later in their pregnancies. The audit period was stretched over 5 years. The diagnostic criteria for gestational diabetes was based on WHO guidelines, meaning fasting venous plasma glucose >7.0 mmol/l or 2 hour after OGTT >7.8 mmol/l.
Results: Of the 43 patients audited 35% were primipara 45% had a BMI of 2025. All women had an OGTT. A large number (68%) of women were diagnosed at 3140 weeks of pregnancy. All women were given dietary advice and 77% of them required treatment with insulin 57% delivered via caesarean section which in some cases was done as emergency operation. Apart from 13% of babies who had foetal macrosomia, there were no other perinatal complications. Only 5% ladies developed diabetes later which needed treatment. However an astonishing 19% of women did not turn up for OGTT at 68 weeks post-partum despite reminders.