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Management of gestational diabetes in primary care

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Understanding gestational diabetes is important to primary care nurses, not only because of a need to be aware of complications that can arise during pregnancy but because of the future risk of type 2 diabetes in the mother-more than seven times that of women who have not had a previous diagnosis of gestational diabetes.1

The classic definition of gestational diabetes is glucose intolerance with onset or first recognition in pregnancy. Leaving aside women with a diagnosis of type 1 or type 2 diabetes before conception, the current prevalence of gestational diabetes is nine per cent, and the problem is growing, driven principally by increasing obesity.2

Screening

The 2008 NICE guideline on gestational diabetes recommends a selective approach to screening based on risk factors.3 The strongest predictor for gestational diabetes is having the condition in a previous pregnancy, and for these women NICE advises early blood glucose self-monitoring or an oral glucose tolerance test (OGTT) at 16-18 weeks of gestation, repeated at 28 weeks of gestation if the first OGTT is normal.

For women with other risk factors for gestational diabetes, an OGTT between 24 and 28 weeks of gestation is advised.3 NICE recommends using the WHO diagnostic criteria for gestational diabetes.


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