This document discusses guidelines and an audit for the management of gestational diabetes mellitus (GDM). Key findings from the audit of 52 women with GDM include: most women were appropriately screened based on risk factors; the median time from GDM diagnosis to group class was 6 days and to joint clinic was 18 days; and neonatal outcomes were generally good with no shoulder dystocias and 15% NICU admission rate. The document outlines recommendations to further improve timing of clinical contacts and adherence to induction of labor guidelines for GDM patients.

1. Gestational Diabetes
Mellitus
MISS BUSHRA SAEED MRCOG
MISS NABILA IRAM FCPS MRCOG
DR SUMAYA ISLAM
MISS RADHIKA PADMAGIRISON FRCOG
LISTER HOSPITAL
EAST AND NORTH HERTFORDSHIRE NHS TRUST
STEVENAGE, HERTFORDSHIRE, UNITED KINGDOM
NOVEMBER 2019

2. Introduction
 Carbohydrate intolerance resulting in
hyperglycaemia of variable severity with onset or
first recognition during pregnancy (WHO).
 Associated with high incidence of adverse maternal
and fetal outcome
 DM in 5% of Pregnant Women
 GDM 87.5%

3. Policy recommends Screening for
 Pre existing Risk Factor
 BMI above 30 kg/m2
 Previous macrosomic baby weighing 4.5 kg or above
 Previous gestational diabetes
 Family history of diabetes (first-degree relative with diabetes)
 Minority ethnic family origin with a high prevalence of diabetes.
 Risk Factor in Current Pregnancy
 Glycosuria of 2+ or above on 1 occasion or of 1+ or above on 2 or more
occasions
 Macrosomia
 Polyhydraminos

4. Policy recommends
 All women should receive:
 a. Review in group clinic within 1 week
 b. Review in joint clinic within 2 weeks
 GDM on metformin or insulin should be offered delivery
between 38+0 and 40+0
 Diet controlled GDM should be offered delivery before
40+6 (IOL began at 40+4)

5. Methods
 Search of CMIS database using ‘Gestational diabetes
mellitus’ as an antenatal complication.
 Total number of women with GDM
 Period from January 2019 to June 2019
 52 sets of notes were available for review

6. Methods
 We audited:
 No of risk factors present & whether appropriately
screened.
 Timing until review in clinic - both
Group class & Joint clinic
 Mode of delivery, including induction timing
 Neonatal outcomes
 Postnatal DM check

7. Pre existing risk factors
3
5
1
16
0
33
22
Previous GDM PCOS Previous Big Baby Ethnicity Antipsychotic Family Hx BMI

8. Risk factors in current pregnancy
5
2 2
0
1
2
3
4
5
6
LGA Polyhydrominos Glycosuria

9. Timing from Diagnosis to Group
Class
0
10
20
30
40
50
60
70
80
1 week 2 week More
Chart Title
Within 1 week: 67%
Within 2 week: 29%
More then 2 week: 4%

10. Timing from Diagnosis to group
class
 The median time from diagnosis to group class was,
6 Days

11. Timing from Diagnosis to Joint
clinic
0
20
40
60
80
100
1 week 2 week More
Chart TitleWithin 1 week: 8%
Within 2 week: 11%
More then 2 week: 89%

12. Timing from Diagnosis to Joint
clinic
 The median time from diagnosis to joint clinic was;
18 days
 Range: 15 days to 120 days
 At least 3 weeks
 Maximum 9 Weeks ( apart from 1 patient seen after 17
weeks because declined appointment)

13. Onset of Labour
Spontaneous IOL ELCS
Spontaneous Lab: 23%
IOL : 46%
ELCS : 31%

14. Mode of Delivery
12%
46%
27%
15%
Instrumental Del NVD ELCS EMCS

15. Neoatal outcomes
 Birth Weights Mean : 3222 gm
 None of these deliveries had shoulder dystocia
 8 babies had NICU admission ( 15%)

16. Post natal GTT
 48% of patient had GTT arranged by GP
 36 patient had management plan documented in orange
notes ( 77%).
 No orange notes in 5 cases

17. Good practice points
 Improvement in diagnosis to clinical contact times :
From 13 days to 6 days
 Improvement in diagnosis to clinical contact times :
From 32 days to 18 days
 Appropriately following recommendations for IOL
for GDM

18. Current situation /
Recommendations
1. New Diabetic midwife was appointed
2. New MSW was appointed
Current issues:
1. Changed Joint clinic at Lister site on Thursday to ensure
less cancellations when Endocrinologist is on call
2. Plan to support Diabetic midwife clinics by seeing
patients with GDM on diet in other Consultant led clinics.