Diabetes and pregnancy

Question 1

What is gestational diabetes caused by?

Answer 1

Reduced insulin sensitivity

Question 2

Complications of gestational diabetes

Answer 2

Macrosomia
Laege for dates foetus

Question 2

Complications of gestational diabetes

Answer 2

Macrosomia
Laege for dates foetus
->birth risk - shoulder dystocia
Long term risk of T2DM after pregnancy for women

Question 3

Who and when should people be screened for gesttational diabetes?

Answer 3

24-28 weeks gestation
Women with risk factors or prev gestational diabetes
OGTT

Question 4

Risk factors for gestational diabetes testing?

Answer 4

Prev gestational diabetes
Prev macosomic baby > 4.5 kg
BMI > 30
Ethnic origin - black caribbean, middle eastern and south asian
FH diabetes - 1st degree

Question 4

Risk factors for gestational diabetes testing?

Answer 4

Prev gestational diabetes
Prev macosomic baby > 4.5 kg
BMI > 30
Ethnic origin - black caribbean, middle eastern and south asian
FH diabetes - 1st degree

Question 4

Risk factors for gestational diabetes testing?

Answer 4

Prev gestational diabetes
Prev macosomic baby > 4.5 kg
BMI > 30
Ethnic origin - black caribbean, middle eastern and south asian
FH diabetes - 1st degree

Question 5

Features of gestational diabetes in foetus

Answer 5

Large for dates foetus
Polyhydraminos (increased amniotic fluid)
Glucose on urine dipstick

Question 6

How to do an OGTT

Answer 6

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

Question 7

How to manage gestational diabetes

Answer 7

Joint diabetes and antenatal clinics with input from dietician
Learn how to monitor and track blood sugar levels

Question 8

How often to monitor gestational diabetes

Answer 8

4 weekly US scams to monitor foetal growth and amniotic fluid volume from 28 to 36 weeks gestation

Question 9

What is management fro gestational diabetes depending on fasting glucose?

Answer 9

<7mmol/l - trial of diet and exercise for 2 weeks then metformin then insulin
>6 + macrosomia or > 7 - start insulin and metformin

Question 10

When do you start insulin and metformin straigh taway in gestational diabetes

Answer 10

> 6 + complication
7

Question 11

What is used to treat gestational diabetes if decline insulin or cannot tolerate metformin?

Answer 11

Glibenclamide - sulfonylurea

Question 12

NICE targets for blood sugar levels in pregnant women

Answer 12

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

Question 13

What shoudl women take from preconception to 12 weeks gestation if have diabetes?

Answer 13

5mg folic acid

Question 14

When should retinopathy screening be performed in diabetic pregnant women?

Answer 14

After booking and 28 weeks gestation

Question 14

When should retinopathy screening be performed in diabetic pregnant women?

Answer 14

After booking and 28 weeks gestation

Question 14

When should retinopathy screening be performed in diabetic pregnant women?

Answer 14

After booking and 28 weeks gestation

Question 15

NICE recommnedation for delivery planning in pre-existing diabetes pregnant women

Answer 15

37 and 38+6 weeks
Gestational diabetes - up to 40+6

Question 16

What insulin regime is considered during labour for women with type I?

Answer 16

Sliding scale insulin regime
Dextrose and insulin infusion titrated to blood

Question 17

What to do with women with gestational diabetes after birth?

Answer 17

Stop medication
OGTT after 6 weeks

Question 18

What should women with diabetes do after birth>

Answer 18

Lower their insulin doses and bee wary of hypoglycaemia in postnatal period
Insulin sensitivity will increase after birth and with breastfeeding

Question 19

Babies with mothers with diabetes are at risk of

Answer 19

Neonatal hypoglycaemia
Polycythaemia (raised haemoglobin)
Jaundice (raised bilirubin)
Congenital heart disease
Cardiomyopathy

Question 20

Two complications of gestational diabetes

Answer 20

Macrosomia
Neonatal hypoglycaemia
Struggle to maintain supply used to of glucose after birth