A 30-year old with a family history of diabetes, hypertension and cardiovascular disease has an abnormal result on a glucose challenge test in her first pregnancy. What are your next steps?
- All pregnant women should be checked for gestational diabetes at about 26 to 28 weeks.
- High risk women should be checked before conception and at 12, 26 to 28 and 32 weeks’ gestation.
- A shared-care multidisciplinary approach is the key to successful management.
- Lifestyle modification and insulin therapy may be needed.
- Target blood glucose values during the pregnancy are below 5.5 mmol/L before meals and below 7.0 mmol/L two hours after meals.
- Extra obstetric monitoring may be required.
- Advise on the risk of diabetes to the child, with future pregnancies and in the long term.
- Consider assessing other cardiovascular risk factors.