Diabetes and pregnancy Flashcards
What is gestational diabetes caused by?
Reduced insulin sensitivity
Complications of gestational diabetes
Macrosomia
Laege for dates foetus
Complications of gestational diabetes
Macrosomia
Laege for dates foetus
->birth risk - shoulder dystocia
Long term risk of T2DM after pregnancy for women
Who and when should people be screened for gesttational diabetes?
24-28 weeks gestation
Women with risk factors or prev gestational diabetes
OGTT
Risk factors for gestational diabetes testing?
Prev gestational diabetes
Prev macosomic baby > 4.5 kg
BMI > 30
Ethnic origin - black caribbean, middle eastern and south asian
FH diabetes - 1st degree
Risk factors for gestational diabetes testing?
Prev gestational diabetes
Prev macosomic baby > 4.5 kg
BMI > 30
Ethnic origin - black caribbean, middle eastern and south asian
FH diabetes - 1st degree
Risk factors for gestational diabetes testing?
Prev gestational diabetes
Prev macosomic baby > 4.5 kg
BMI > 30
Ethnic origin - black caribbean, middle eastern and south asian
FH diabetes - 1st degree
Features of gestational diabetes in foetus
Large for dates foetus
Polyhydraminos (increased amniotic fluid)
Glucose on urine dipstick
How to do an OGTT
75g glucose drink in morning after fast
blood sugar monitored before and after 2 hours
Fasting <5.6 mmol/l
At 2 hours<7.8 mmol/l
How to manage gestational diabetes
Joint diabetes and antenatal clinics with input from dietician
Learn how to monitor and track blood sugar levels
How often to monitor gestational diabetes
4 weekly US scams to monitor foetal growth and amniotic fluid volume from 28 to 36 weeks gestation
What is management fro gestational diabetes depending on fasting glucose?
<7mmol/l - trial of diet and exercise for 2 weeks then metformin then insulin
>6 + macrosomia or > 7 - start insulin and metformin
When do you start insulin and metformin straigh taway in gestational diabetes
> 6 + complication
7
What is used to treat gestational diabetes if decline insulin or cannot tolerate metformin?
Glibenclamide - sulfonylurea
NICE targets for blood sugar levels in pregnant women
Fasting: 5.3 mmol/l
1 hour post-meal: 7.8mmol/l
2 hours post-meal: 6.4 mmol/l
Avoiding levels of 4 mmol/l or below
What shoudl women take from preconception to 12 weeks gestation if have diabetes?
5mg folic acid
When should retinopathy screening be performed in diabetic pregnant women?
After booking and 28 weeks gestation
When should retinopathy screening be performed in diabetic pregnant women?
After booking and 28 weeks gestation
When should retinopathy screening be performed in diabetic pregnant women?
After booking and 28 weeks gestation
NICE recommnedation for delivery planning in pre-existing diabetes pregnant women
37 and 38+6 weeks
Gestational diabetes - up to 40+6
What insulin regime is considered during labour for women with type I?
Sliding scale insulin regime
Dextrose and insulin infusion titrated to blood
What to do with women with gestational diabetes after birth?
Stop medication
OGTT after 6 weeks
What should women with diabetes do after birth>
Lower their insulin doses and bee wary of hypoglycaemia in postnatal period
Insulin sensitivity will increase after birth and with breastfeeding
Babies with mothers with diabetes are at risk of
Neonatal hypoglycaemia
Polycythaemia (raised haemoglobin)
Jaundice (raised bilirubin)
Congenital heart disease
Cardiomyopathy
Two complications of gestational diabetes
Macrosomia
Neonatal hypoglycaemia
Struggle to maintain supply used to of glucose after birth
