7.6. Complications of Pregnancy - Diabetes

Question 1

What are the 2 forms of Diabetes concerned, in relation to Pregnancy?

Answer 1

1. Pre-Existing Diabetes

2. Gestational Diabetes

Question 2

Which form of Pre-Existing Diabetes is more common?

Answer 2

Type 1

Question 3

What is Gestational Diabetes?

Answer 3

1. Carbohydrate Intolerance with onset (or First Recognised) in Pregnancy
2. Abnormal Glucose Tollerance Test that reverts to normal after Delivery
   Note - Those with Gestational Diabetes are more at risk of Developing Type 2 Diabetes later in life

Question 4

With regards to a Mother with Pre-Existing Diabetes, what happens to the Insulin Requirement of her?
Why?

Answer 4

They Increase due to the following Hormones having an Anti-Insulin Action:
1. Human Placental Lactogen
2. Progesterone
3. Human Chorionic Gonadotrophin
4. Cortisol
Note - Be aware of the Risk of Hypoglycaemia

Question 5

With regards to a Mother with Pre-Existing Diabetes, what happens to her child?
Why?

Answer 5

Foetal Hyper-Insulinaemia occurs.
Maternal Glucose crosses the Placenta and Induces Increased Insulin Production in the Fetus.
The Foetal Hyperinsulinaemia cases Macrosomia

Question 6

What does Diabetes in the Mother cause an increased risk of?

Answer 6

1. Foetal Congenital Abnormalities
2. Miscarriage / Stillbirth
3. Pre-Eclampsia
4. Foetal Macrosomia, Polyhydramnios
5. Operative Delivery / Shoulder Dystocia
6. Worsening of Maternal Nephropathy / Retinopathy / Hypoglycaemia / Reduced awareness of Hypoglycaemia
7. Infections

Question 7

What is the management of Diabetes of a Mother, Pre-Conception?

Answer 7

1. Better Glycaemic Control
2. Folic Acid - 5mg
3. Dietry Advice
4. Retinal / Renal Assessment

Question 8

What is the Ideal Blood Sugars for a Diabetic Mother Pre-Conception?

Answer 8

4-7mmol/l

HbA1C < 6.5% (<48mmol/l)

Question 9

How is medication for a Pregnant Diabetic Mother altered?

Answer 9

1. Can continue Oral Anti-Diabetic Agents (Metformin)

2. May need to change to Insulin for Tighter Glucose Control

Question 10

When is labour induced in Pregnancy?

Answer 10

1. 38-40 weeks - Earlier if there is Foetal / Mother concerns
2. C-Section Considered

Question 11

What should be observed for in a Diabetic Pregnant Mother, whilst giving Birth?

Answer 11

1. Pre-Eclampsia
2. Maintain Blood Sugar with Insulin-Dextrose Infusion
3. Continuous CTG Foetal Monitoring

Question 12

What are the Risk Factors for developing Gestational Diabetes?

Answer 12

1. Increased BMI - > 30
2. Previous Macrosomic Baby - > 4.5kg
3. Previous Gestational Diabetes
4. Family History of Diabetes
5. Women from High Risk Groups of Developing Diabetes
6. Polyhydramnios / Big Baby in current Pregnancy
7. Recurrent Glycosuria in current pregnancy

Question 13

What is Gestational Diabetes associated with?

Answer 13

1. Increase in Maternal Complications (e.g. Pre-Eclampsia)

2. Increase in Foetal Complications (Macrosomia)

Question 14

1. What is the Screening for Gestational Diabetes?

2. And when is it used?

Answer 14

1. HbA1C

2. Oral Glucose Tolerance Test - If HbA1C > 6% (43mmol/mol)

Question 15

What is the Management of Gestational Diabetes?

Answer 15

1. Control Blood Sugars - Diet / Metformin / Insulin

2. Chech Oral Glucose Tolerance Test 6-8 weeks Post-Delivery