Diabetes and Pregnancy Flashcards
the detection of which hormone is used in pregnancy tests
hCG - produced by the placenta after implantation
what is an ovum
a mature female reproductive cell that can divide to give rise to an embryo after fertilization
gestational diabetes
high blood sugar levels that develop during pregnancy and usually disappear after giving birth
typically asymptomatic and will remit following delivery
who is at risk of GDM
previous history of GDM and overweight
describe the pathophysiology of GDM
during pregnancy, high levels of hPL, hPGH, oestrogen and progesterone as produced
these (in particular hPL) reduce the effectiveness of insulin in the mother to help direct the blood sugars to the baby
as the levels of these hormones increase as the baby grows, the likelihood of developing insulin resistance and GDM increases
when do complications from maternal diabetes arise in the baby
3rd trimester
congenital malformation
foetal organogenesis starts at 5 weeks, high sugars interrupt this so there is a higher risk of congenital malformation
pre-conception in all diabetics
Offer general advice, and discuss risks
Control/reduce weight, aim for good glucose control, offer folic acid 5mg/day until 12 weeks.
Oral hypoglycaemics other than Metformin should be discontinued.
complications in pregnancy due to DM
congenital malformation
miscarriage, pre-term labour, pre-eclampsia, prematurity, intra uterine growth retardation, macrosomia, polyhydramnios, intrauterine death
what problems can macrosomia cause during labour
genital tract lacerations, bleeding after delivery, uterine rupture
what is a complication often seen in the neonate
respiratory distress - premature babies dont have enough surfactant - increased effort in expanding the lungs which damages the cells
why is there an increased risk of macrosomia in GDM and poorly controlled diabetes
maternal hyperglycaemia leads to foetal hyperglycaemia - extra glucose is stored in the foetus as fat causing macrosomia
maternal hyperglycaemia effect on foetus (poorly controlled DM and GDM)
glucose crosses the placenta, insulin doesn’t
maternal hyperglycaemia leads to foetal hyperglycaemia - foetal hyperinsulinaemia to compensate for increased blood glucose levels
following birth, the hyperglycaemic maternal blood is no longer available and neonate becomes hypoglycaemic
treatment of neonatal hypoglycaemia
high dose glucose
subsides after a few days
treatment of GDM
lifestyle and Metformin, insulin may be required
6 week post natal OGT is required to ensure resolution of GDM - if not there may be a diagnosis of T2DM
