19. Pregnancy and Diabetes

Question 1

why does diagnosing maternal hyperglycaemia matter?

Answer 1

prevents morbidity in offspring
prevents exacerbation of obesity and T2 diabetes epidemic
reduces future T2 diabetes in mother

Question 2

pre-gestational hyperglycaemia

Answer 2

type 1 diabetes
type 2 diabetes
monogenic diabetes
impaired glucose tolerance (IGT)

Question 3

gestational diabetes

Answer 3

any newly found abnormal glucose tolerance test after 1st trimester pregnancy

Question 4

WHO definition of gestational diabetes

Answer 4

diabetes OR impaired glucose tolerance

Question 5

what happens in 1st trimeter

Answer 5

organogenesis
carefully design essential components
avoid mistakes
construct and programme the placenta

Question 6

what happens in 2nd trimester

Answer 6

further complex development and linkage

Question 7

what happens in 3rd trimester

Answer 7

accelerated growth

Question 8

maternal metabolism during pregnancy

Answer 8

changes as pregnancy progresses
early = facilitated anabolism
late = facilitated catabolism

Question 9

facilitated anabolism

Answer 9

early pregnancy
increased insulin sensitivity
glucose concentration slightly lower
increased maternal energy stores

Question 10

facilitated catabolism

Answer 10

later pregnancy
increased insulin resistance
increased transplacental passage of nutrients
rapid foetal growth

Question 11

effects of maternal hyperglycaemia in 1st trimester

Answer 11

hydrocephalus
congenital heart disease
meningomyelocoele 
ventral/sacral dysgenesis
renal agenesis

Question 12

how to prevent malformation in hyperglycaemia of pregnancy

Answer 12

start preconception (if diabetes known)
good diabetes control in 1st trimester: prepregnancy counselling (lifestyle modification, intensive glucose monitoring, insulin regimen)

Question 13

prevention of foetal malformation in primary care

Answer 13

identify unknown cases of diabetes/IGT by checking women with risk factors

Question 14

risk factors of hyperglycaemia in pregnancy (screening)

Answer 14

previous gestational diabetes 
obesity 
polycystic ovarian syndrome 
family history of T2 diabetes 
older age 
high risk racial group

Question 15

problems in 3rd trimester (due to maternal hyperglycaemia)

Answer 15

macrosomia and associated problems
pre-eclampsia
foetal or neonatal death

Question 16

macrosomia risks

Answer 16

difficult birth 
shoulder dystocia 
breathing problems 
jaundice
hypoglycaemia

Question 17

lifelong foetal sequelae

Answer 17

obesity 
insulin resistance
type 2 diabets 
dyslipidaemia 
hypertension 
vascular disease

Question 18

treatment for hyperglycaemia in pregnancy

Answer 18

good maternal glucose control (blood monitoring) 
appropriate nutrition 
reasonable exercise 
ultrasound monitoring of foetal girth 
maternal observation of foetal movements

Question 19

drug treatment for good maternal glucose

Answer 19

prepregnancy - basal bolus insulin regimen

gestational diabetes - metformin, basal insulin, basal bolus insulin

Question 20

diabetes/GSM post partum

Answer 20

maintain good glycaemic control
advice re next pregnancy 
contraception advice 
encourage long term glycemic control 
encourage breast feeding

Question 21

breast feeding and obesity

Answer 21

reduces risk in child by 30-50%

reduces postpartum weight gain in mother

Question 22

specific GSM management post partum

Answer 22

screen for diabetes 12 weeks post partum
lifestyle advice
annual glucose screening (50% develop T2 diabetes)

Question 23

contraceptives and diabetes/IGT

Answer 23

progesterone only pill
combined oCP after 6 weeks
mirena intrauterine system
sterilisation