12.6 Hyperglycemia In Pregnancy

Question 1

GDM vs DM: what is the differences?

Answer 1

Gestational Diabetes Mellitus (GDM):
- Onset: develops specifically during pregnancy (second or third trimester)
- Cause: body cannot produce enough insulin to meet the increased needs during pregnancy. Hormonal changes in pregnancy can lead to insulin resistance, where the body’s cells don’t respond to insulin effectively.
- Risk Factors: overweight, family history of diabetes, or have had GDM in a previous pregnancy

Diabetes Mellitus (DM):
- Types: chronic condition characterized by persistently high blood sugar levels. Type 1 & 2
- Complications: DM can lead to long-term complications affecting various organs and systems, including the heart, kidneys, eyes, and nerves.

Question 2

What is the short-term adverse risk for a woman and her unborn child with uncontrolled pre-existing diabetes?

Answer 2

Short-term complications to the mother
- Preeclampsia and eclampsia
- Prolonged labour or dystocia
- Cesarean delivery
- Surgical complication
- Postpartum hemorrhage

Short-term complications to the offspring
- Fetal macrosomia
- Shoulder dystocia
- Collarbone fracture
- Brachial plexus injury
- Asphyxia

Question 3

In what ways does GDM adversely affect the mother and fetus in short term?

Answer 3

Maternal complications:
- Hypertensive disorders in pregnancy
- Failure to progress in labour
- Caesarean section
- Instrumental delivery
- Pre-term delivery
- Preeclampsia

Foetal complications:
- Large for gestational age/ macrosomia
- Perinatal death
- Shoulder dystocia and related birth injuries
- Neonatal hypoglycaemia
- Increased admission to NICU
- Hyperbilirubinaemia

Question 4

Describe the changes in insulin sensitivity in a pt who had well controlled DM throughout pregnancy and in peripartum period

Answer 4

• Improved Insulin Sensitivity During Pregnancy: During the first half of pregnancy, many women experience improved insulin sensitivity. This is partly due to hormonal changes, including increased levels of insulin-sensitizing hormones like estrogen and progesterone. In well-controlled DM, this improved sensitivity can help manage blood sugar levels more effectively.
• Increased Insulin Resistance in the Second Half of Pregnancy: As pregnancy progresses, especially in the second and third trimesters, insulin resistance tends to increase. This is primarily driven by placental hormones, such as human placental lactogen and cortisol, which can interfere with insulin action. In women with pre-existing DM, this increased insulin resistance may necessitate adjustments to insulin therapy or other medications to maintain good blood sugar control.
• Peripartum Changes: In the immediate period before and after childbirth (peripartum), there can be significant fluctuations in insulin sensitivity. These changes can vary widely among individuals and depend on factors like the type of DM (Type 1 or Type 2), the management approach, and overall health.
  • During Labor: Some women with well-controlled DM may experience improved insulin sensitivity during labor, potentially requiring a reduction in insulin doses or adjustments to other diabetes medications.
  • After Delivery: After childbirth, hormone levels that contributed to insulin resistance during pregnancy begin to decline rapidly. For women with gestational diabetes, blood sugar levels often return to normal shortly after delivery. In those with pre-existing DM, insulin requirements may decrease as insulin sensitivity improves
• Postpartum Monitoring: It’s essential for women with DM who have well-controlled blood sugar during pregnancy to continue close monitoring in the postpartum period. Some women may still need insulin or other medications after childbirth, while others may find they can gradually reduce their medication requirements as insulin sensitivity continues to improve.