Glucose intolerance first recognised in pregnancy, increasing macrosomia, shoulder dystocia and neonatal hypoglycaemia risk.
Investigations
- • 75 g OGTT at 24–28 weeks (earlier if high risk)
- • Diagnostic: fasting ≥5.1, 1 h ≥10.0 or 2 h ≥8.5 mmol/L (IADPSG)
- • Growth scans, liquor volume
Management
- • Diet and exercise trial for 1–2 weeks
- • Metformin first-line pharmacotherapy; add or switch to insulin if targets missed
- • Targets: fasting <5.3, 1 h post-meal <7.8 mmol/L
- • Deliver by 40–41 weeks; earlier if macrosomia or poor control
Clinical pearls
- • Stop hypoglycaemic agents after delivery and check glucose
- • Postnatal OGTT/HbA1c at 6–13 weeks then annual screening — 50% develop T2DM within 10 years
Related in WardRound
Educational — verify locally.
