April 25, 2016 - SG9 - Diabetes in Pregnancy

Question 1

Contraindications to Planned Pregnancy

Answer 1

Individuals should perhaps not become pregnant (if possible), if they have gastroparesis or coronary artery disease.

Question 2

Insulin Demands During Pregnancy

Answer 2

Insulin demands may take an initial drop due to vomitting and nausea, but will then increase during her second and third trimester. Insulin requirements will rise during pregnancy due to human placental growth hormone. Once the placenta is out, insulin demands will return to pre-conception levels (or slightly lower).

Question 3

Human Placental Growth Hormone (HPGH)

Answer 3

The main hormone responsible for the increase in insulin demands during pregnancy.

Question 4

Complications in Pregnancy (Diabetics)

Answer 4

Big risk for birth defects during the first trimester of pregnancy. This risk can be lowered with tight glycemic control.

Late complications in pregnancy include having to break the shoulder of the baby (which can damage the brachial plexus), higher levels of trauma to the woman, more c-sections, and stillbirths (but not in gestational diabetes).

Question 5

Heredity of Diabetes

Answer 5

Type 1 - 5%

Type 2 - 50%

Question 6

Acanthosis Nigracans

Answer 6

Caused by lots of insulin

Question 7

Risk Factors for Gestational Diabetes

Answer 7

Previous gestational diabetes

FHx of diabetes

History of steroids

Non-caucasians

BMI > 30

Polycystic ovarian syndrome

Big kids in the past

Age > 35

Acanthosis nigricans

Question 8

Testing for Gestational Diabetes

Answer 8

The mother is given a 50g oral glucose test and then examined after 1 hour.

If high or inconclusive, give a 75g oral glucose test and examine the blood at 1 hour and 2 hours.

If blood glucose levels are high, she likely has gestational diabetes. Try two weeks of nutrition counselling and exercise with reduced carbohydrates and retest. If still high, first line treatment is insulin and second line is metformin.