Diabetes Flashcards
Role of cortisol in pregnancy DM
Placenta produces cortisol –> glucose production
Also produces human placental laxctogen, progesterone, hCG –> increased glucose levels
Impaired glucose tolerance of pregnancy
Rise in glucose levels but not levels with a Dx of GDM
Complications (foetal)
Congenital abnormality (NTD and cardiac) Preterm labour (10%) Decreased foetal lung maturity Macrosomia --> birth trauma Polyhydramnios Foetal distress/death
Complications (maternal)
DKA
Hypoglcyaemia
Infection - UTIs, wound, endometrial post-partum
Pre-eclampsia
Exacerbation of IHD
CS or instrumental delivery (due to macrosomia)
Diabetic neuropathy/retinopathy
Complications - SMASH
Shoulder dystocia Macrosomia Amniotic fluid excess Stillbirth HTN + neontal hypoglycaemia
Preconceptual care of pre-existing diabetic women?
Glucose control Baseline renal function, BP, IHD and retinal assessment 5mg folic acid Labetalol/methyldopa for BP Lifestyle and smoking/alcohol
ANC of pre-existing DM
<34 weeks: 2 weekly visits
>34 weeks: weekly visits
Monitor for polyhydramnios, macrosomia, IUGR
Home glucometer: <6mmol/L
Dietician review
Foetal monitoring
Normal scans + fetal echocardiography
USS for growth and liquor volume
Delivery
39 weeks
Elective CS if baby >4kg
During labour - insulin sliding scale + dextrose infusion
Post-partum
Foetus can develop hypoglycaemia (raised insulin due to tolerance of hyperglycaemia)
Breast-feed
Risk factors for GDM
Hx: GDM, fetus>4.5kg, stillbirth First-degree relative with DM BMI>30 Ethnicity Polyhydramnios PCOS
Screening for GDM
Women at risk - screened at 28 weeks with GTT:
Give 75mg –>
Fasting <7mmol/L
2h >7.8 (+ve diagnosis)
Management of GDM
- Give glucometer
- Oral hypoglycemic - metformin + diet + exercise (60% will achieve control)
- Insulin
Serial growth scans
Postnatal management of GDM
Stop insulin
GTT at 3 months
50% develop DM in 10 years
