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Women's Health > 2 - Diabetes in Pregnancy > Flashcards

2 - Diabetes in Pregnancy Flashcards

1
Q

What are the two types of diabetes mellitus in pregnancy?

A

Pre-gestational diabetes

Gestational diabetes

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2
Q

What % of diabetes in pregnancy is pre-gestational : gestational?

A

90% Pre-gest

10% Gest

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3
Q

Why might the complications of pre-gestational DM differ from gestational DM?

A

Pre-gestational GM would expose the fetus to blood sugar abnormalities at the point of conception onwards + during organogenesis

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4
Q

What type of drug is ramipril?

What time periods should Ramipril be avoided during a pregnancy?

What effect can ramipril have on maternal physiology during pregnancy?

A

ACE inhibitor

ACE inhibitors should be avoided in 2nd/3rd trimester.

Risk of fetal renal damage

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5
Q

What type of drug is Propylthiouracil (PTU)?

Why is Propylthiouracil contra-indicated in pregnancy?

A

Associated with severe liver disease / failure during pregnancy

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6
Q

What type of drug is Nitrofurantoin?

After what week is Nitrofurantoin contra-indicated in pregnancy?

Why is this the case?

A

Antiobiotic (UTI specific)

Avoided after 36/40 due to increase risk of haemolytic anaemia

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7
Q

What class of drug is: Citalopram?

What the effects of citalopram on pregnancy, and is it deemed safe?

A

SSRI

Associated with congenital heart disease when taken in 1st trimester.

However, if required for maternal mental health, advisable NOT to stop.

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8
Q

What class of drug is: Lamotrigine ?

What are the effects of lamotrigine on pregnancy, and is it deemed safe?

A

Anti-epileptic drug (AED)

Generally considered safe compared to others (lower risk-profile)

Some concerns regarding risk of congenital malformations when compared to women not on AEDs.

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9
Q

What are the two complications of taking NSAIDs during a pregnancy?

A

Increased risk of:

1) oligohydramnios
2) premature closure of fetal ductus arteriosus

Can be used in severe inflammatory conditions.

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10
Q

Why is Trimethoprim contra-indicated in pregnancy?

At what point during pregnancy is it considered safe?

A

Interferes with folica acid pathway - therefore considered TERATOGENIC in 1st trimester.

However, generally considered safe afterwards.

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11
Q

Why is Sodium Valproate contra-indicated in pregnancy?

A

High association with congenital malformations, therefore, AVOIDED.

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12
Q

For what reason is Carbimazole contra-indicated in pregnancy?

A

Associated with rare skin disorder if taken in 1st trimester: aplasia cutis.

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13
Q

What complications / features are more likely to occur as a result of DM during pregnancy?

A 
Macroscomia
Polyhydramnios
Shoulder dystocia
Stillbirth
Neonatal hypoglycaemia
Expedited delivery
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14
Q

How might an increased BMI affect the outcome of a pregnancy? What are the complications?

A 
Pre-eclampsia
VTE risk
Fetal monitoring difficulties
Anaesthetic risk
Postpartum haemorrhage (PPH)
Infection
VTE
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15
Q

What is the incidence (as a %) of GDM across all pregnancies?

A

2-9%

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16
Q

What is the underlying principle / inbalance that results in GDM manifesting?

A

Insulin resistance outweighs increased insulin production

17
Q

What hormones are responsible for mediating the increase in insulin resistance during pregnancy?

A

hPL
GH
Cortisol

18
Q

What are the 5 risk factors that may predispose a prospective mother of developing GDM?

A 
BMI > 30
Previous birth > 4.5kg
Previous GDM
1st degree relative w/ DM
Ethnic origin (South asia, Black carribean, Middle east)
19
Q

When (in weeks) and how is GDM diagnosed in pregnancy?

A

28 weeks

OGTT

20
Q

According to NICE guidelines, what are the BM targets during pregnancy?

(Fasting / Post-meal)

A

3.5-5.5mmol/L Fasting

<7.8mmol/L Post-meal

21
Q

What is the recommended target HbA1c prior to pregnancy?

A

< 48 mmol/L

22
Q

What are the differences in the complications of:

Pre-gestational DM vs. gestational DM?

Why is this the case?

A

Complications of pre-gestation AND gestational DM:

  • Growth abnormalities
  • Preterm labour
  • Still birth

ONLY pre-gestational ALSO includes

1) Fetal abnormalities
2) Miscarriage

This is because the effects of hyperglycaemia will be present early on during fetal development, including throughout ORGANOGENESIS.

23
Q

Explain the Pederon Hypothesis (Effect of gestational DM leading to macrosomia)

A 
Maternal hyperglycaemia
> Fetal hyperglycaemia
 > Fetal insulin production increase
  > Insulin is a growth factor
>>> Macrosomia
24
Q

Folic acid supplementation should start how long before pregnancy?

A

3/12

25
Q

By how much, and for what reason, should folic acid supplementation be increased in GDM?

A

Increase to 5mg

GDM imposes higher risk of NTD.

26
Q

According to the NICE guidelines, when should pregnant women with either T1DM or T2DM be offered elective delivery by?

A

37-38+6 weeks for any mother with pre-existing DM.

27
Q

According to NICE guidelines, when should women be offered delivery if there are ANY maternal / fetal complications?

A

Women should be offered delivery prior to 37/40 if there are any maternal or fetal complications.

28
Q

According to the NICE guidelines, when should women with GDM be offered an elective delivery?

What methods of delivery should be offered?

A

By 40+6 IF they haven’t delivered yet.

Delivery should be performed either by:

  • IOL (induction of labour)
  • LSCS
29
Q

According to the NICE guidelines, women with diabetes in pregnancy should be offered elective LSCS if the EFW is >4.5kg in order to reduce the risk of what?

A

In women with diabetes in pregnancy and an estimated fetal weight >4.5kg, an elective LSCS should be considered to reduce the risk of SHOULDER DYSTOCIA.

30
Q

According to NICE, in non-diabetic pregnancies, what is EFW threshold to be offered elective LSCS?

A

> 5.0 kg

31
Q

According to NICE, how frequently should babies be fed and monitored in order to minimise the risk of neonatal hypoglycaemia?

At what blood glucose level should this be maintained until? (mmol/L)

A

NICE guidance Diabetes in Pregnancy recommends that women feed their babies as soon as possible (within 30 minutes of birth) and then at frequent intervals (2–3 hours).

This should occur until pre-meal blood glucose levels are maintained at 2 mmol/litre or more.

32
Q

Which of the following is NOT an increased risk for pregnancies of mothers with diabetes?

1) (fetal) Macrosomia
2) unexplained stillbirth
3) Oligohydramnios
4) Congenital malformations

A

Oligohydramnios

In DM pregnancies, the risk is of polyhydramnios (too much amniotic fluid).

Women's Health (3 decks)

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