April 20, 2016 - Diabetes in Pregnancy

Question 1

Insulin Requirements During Pregnancy

Answer 1

Lowest in the first trimester (throwing up etc.)

Highest in the 3rd trimester of pregnancy (double or triple the woman before she got pregnant)

* It is normal in pregnancy to develop insulin resistance *

Question 2

Gestational Diabetes

Answer 2

Pregnancy-induced glucose intolerance.

Diabetes developed in pregnancy when the mother’s pancreas cannot keep up with the increased insulin resistance in pregnancy (particularly in the 2nd/3rd trimester)

Question 3

Counter-Regulatory Hormones in Pregnancy

Answer 3

Human Placental Growth Hormone (Human Placental Lactogen)

TNFa

Progesterone

Question 4

Post-Partum Insulin

Answer 4

Insulin requirements go back down to pre-pregnancy requirements, and sometimes even a bit less than before if there is breastfeeding.

Question 5

Hyperglycemia and Teratogen

Answer 5

FIX BLOOD SUGARS BEFORE BEING PREGNANT

Neural tube and fetal hearts develop at around 4 weeks. If blood sugars are high at this time, complications can occur.

Question 6

Adverse Pregnancy Outcomes Related to Hyperglycemia

Answer 6

1st trimester = increased risk of fetal malformations

2nd/3rd trimester = increased risk of big baby and metabolic complications

Question 7

Fetal Abnormalities in Poorly Controlled Pregnancies

Answer 7

Cardiac malformations

Multiple organs

CNS deficiencies - spina bifida or ancephaly

Situs inversus

Renal agenesis

Duplex ureter

Caudal regression

Miscarriage

Question 8

Neonatal Hypoglycemia

Answer 8

If the mom’s blood sugar is high at time of delivery, the baby’s pancreas is making lots of extra insulin. When the baby is born and isn’t exposed to the high blood sugar, it still has the high amount of insulin and can result in hypoglycemia for the baby.

Question 9

Management of Diabetes in Pregnancy

Answer 9

1. Preconception counseling (A1C < 7.0%)
2. Management during pregnancy (make sure neuropathy or retinopathy doesn’t get much worse during pregnancy)
3. Management in labour
4. Postpartum considerations

Question 10

Postpartum Care for Women w/ DM1 or DM2

Answer 10

Adjust in the insulin as they are at risk for hypoglycemia. Return to their pre-pregnancy dose or less

Encourage women to breastfeed

Screen for postpartum thyroiditis

Question 11

Prevalence of Gestational Diabetes

Answer 11

5%

Increased risk significantly of getting DM2 later in life.