A woman attends the antenatal day assessment unit to discuss the result of her glucose tolerance test. She is 42 years old and this is her sixth pregnancy. She has previously had three Caesarean sections, one early miscarriage and a termination of pregnancy. All bookin)
tests were normal as were her 11-14-week and anomaly ultrasound scans.
The woman is of Indian
ethnic origin but was born and has always lived in the UK. She is now 26 weeks’ gestation and her midwife arranged a glucose tolerance test because of a
family history of type 2 diabetes (her father and paternal aunt).
Examination
The body mass index (BMI) is 31 kg/m2. Blood pressure is 146/87 mmHg. The symphysiofundal height is 29 cm and the fetal heart rate is normal on auscultation.
INVESTIGATIONS
Urinalysis: 1glycosuria
Glucose tolerance test (75 g glucose drink):
pretest fasting blood glucose: 6.4 mmol/L;
1h blood glucose following 75 g oral glucose load: 10.5 mmol/L.
2h blood glucose following 75 g oral glucose load: 11.3 mmol/L
Questions
What is the diagnosis and on what criteria can this be made?
What are the principles of management for this patient?