Diabetes and Pregnancy Flashcards
which relevant drugs nmust be stopped
all oral hypoglycaemics except Metformin
ACEi, statin
what extra medication needs to be taken
folic acid 5 not 4
any type of diabetes is a risk factor for pre-eclampsia - 75mg aspirin from 12 weeks until delivery
do you deliver the baby at teh same time?
no, deliver at 38 weeks, earlier if complications
what is the biggest risk factor for GDM
previous GDM
outline the pathophysiology of GDM
- degree of insulin resistnace develops through pregnancy, partly because hPL, cortisol, hPHG, oestrogen and progesterone are insulin antagonists
- the beta cells can compesnate to an extent by producing more insulin, eventually this fails
- in people with comorbidities/risk factors pancreas wont be able to compensate for as long
- serum glucose level rise and when excessive they can cause foetal complications
there are 2 types of screening for GDM, tell me about them
- positive risk factors identified at booking - OGTT at 24-28 weeks
- previous GDM - OGTT at booking
how is the OGTT performed
fast overnight, meausre venous fasting BG, administer 75g glucose and measure BG 2 hours later
OGTT results - diagnosis of GDM
- fasting plasma glucose level of 5.1 mmol/litre or above or a 2‑hour plasma glucose level of 8.5 mmol/litre or above
what other clinical finding would make you consider an OGTT
urine found on dipstick at any point
what is monitored during pregnancy in someone with GDM
- BP
- blood glucose
- pre eclampsia
- serial US to monitor foetal growth and liquor volume
regularly !
management of GDM generally
weight, lifestyle
metformin
insulin
when is the baby delivered in GDM
early! the risk of stillbirth increases closer to full term in macrosomic babies
offer IOL around 38 weeks
can you have a vaginal delivery in GDM ?
yes, it is not contraindicated by macrosomia but there are risks, such as shoulder dystocia, failure to progress etc
also more pain???
what weight of the baby is an indication for C section and why
>4.5kg
there is a significant risk of cephalopelvic disproportion and shoulder dystocia
how is glucose control managed during delivery
if it is >7 would usually give an insulin sliding scale
what is the mother more prone to getting with GDM
skin and urinary tract infections due to hyperglycaemia
what is the mechanism behind polyhydramnios in GDM
foetal polyuria
what is the mechanism behind IUGR in GDM
poor matenreal nutrition and placental vascular dysfucntion
what problems can macrosomia cause during delivery
genital tract lacerations, bleeding, uterine rupture, shoulder dystocia
what neurological problem can shoulder dystocia cause
Erb’s palsy (C5 and 6) - waiters tip
what is the mechanism behind respiratory distress in neonates
delayed pulmonary surfactant production
complciations in neonates with GDM
- respiratory distress
- hypoglycaemia secondary to hyperinsulinaemia
- polycythaemia
- jaundice
why do you et polycythaemia in the neonate
because the intrauterine hypoxia is a stimulus for EPO production
how do you manage the mother after delivery in GDM
stop the insulin
monitor baby for comlpications
what are the risks for teh mother after having had GDM
50% develop T2DM in 10 years
and risk of recurrence
with this in mind, what check is done on the mother’s glucose levels post partum
check maternal fasting blood glucose 6 weeks after to ensure remission
