The use of insulin, considered a high-risk medication with APINCHs classification,5 Ms Barwick notes, provides justification for a Home Medicines Review (HMR). ‘There’s an advantage to going into the home to observe the patient’s diet, consider potential interactions, and educate patients on the best effects and outcomes,’ she says.
Advice around cleaning blood glucose level (BGL) monitors to ensure accuracy can also be provided. ‘Pharmacists can explain how to put test drops through and clean blood spills on the monitor, common in pregnancy due to higher blood volume,’ says Ms Barwick.
With only 50% of women diagnosed with GDM receiving tests for heart disease and type 2 diabetes post-pregnancy,6 HMRs can be beneficial at this stage of the journey, too.
‘Along with conversations around diet choices, exercise regimes and sleep, I also explain how often testing is required over the next 5–10 years, and how to monitor for signs of the development of diabetes,’ Ms Barwick advises.
Nausea and vomiting in pregnancy
The presence of iron in pregnancy multivitamins may exacerbate symptoms of nausea and vomiting in some pregnancies, according to Ms Barwick.
‘Pharmacists can recommend a trial cessation of the iron component of pregnancy vitamins, often unnecessary in pregnancy,’ she says.
In 2020, photographer Bobbi Lockyer created a Birthing on Country project to highlight and create awareness around birthing issues and outcomes in Aboriginal women. For more, see 
Suzanne Nielsen MPS[/caption]
Case scenario
Sophie, a 30-year-old pregnant woman, presents to the pharmacy with a prescription for insulin. She has recently been diagnosed with gestational diabetes mellitus and is anxious about administering insulin, as she has only ever taken oral medicines and doesn’t want to take anything to harm her baby.
Introduction
Gestational diabetes mellitus (GDM) is characterised by any degree of glucose intolerance (hyperglycaemia) which develops or is first recognised during pregnancy.1 In most cases, it is asymptomatic and diagnosed on routine testing at 24–28 weeks’ gestation.
Maternal hyperglycaemia leads to fetal hyperglycaemia and hyperinsulinaemia, which impacts both perinatal and long-term health outcomes in offspring.2,3 Adverse outcomes for the offspring include increased birth weight (macrosomia) (OR 1.8 [95% CI 1.7, 1.8]), excess fetal adiposity (per cent body fat), and increased umbilical cord C-peptide (reflects the insulin-secretory activity of pancreatic beta cells).2–4
A high birth weight may complicate vaginal delivery (e.g. by increasing risk of shoulder dystocia), put the mother and baby at risk of injury from the birthing process, and also leads to a higher rate of delivery by caesarean section (OR 1.4 [95% CI 1.4, 1.4]).4 After delivery, there is an increased risk of neonatal hypoglycaemia. Long-term risks of macrosomia in infants of women with GDM include childhood cardiovascular disease.2–5
As the most accessible health professionals, pharmacists play an important role supporting women with GDM, particularly around blood glucose monitoring, medicine use (if needed), and encou
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