Diabetes and pregnancy Flashcards
Name 6 foetal risks of diabetic mothers.
- Macrosomia- birthweight above the 90th percentile, increased risk of obesity and T2DM.
- pre-term delivery
- Neonatal care admission
- Congenital malformation
- Foetal mortality
- Stillbirth
What 7 criteria need to be fulfilled for adequate pre-conception management of diabetes?
- Optimised pre-conception glycaemic control. HbA1c aim of 43.
- High dose folic acid supllements
- Review potentially teratogenic drugs
- Advice on losing weight
- Advice on smoking cessation, alcohol reduction/cessation, avoiding unpasteurised dairy products
- Screening for retinopathy and nephropathy
- Metformin can be used as an adjunct to insulin
Name 7 risks to diabetic mothers during pregnancy.
- Increased risk of severe hypoglycaemia, especially early on
- Increased risk of pre-eclampsia
- Worsening of diabetic retinopathy and nephropathy
- Increased risk of DKA
- Increased delivery by caesarean
- Increased risk of thromboembolic disease
- Thyroid dysfunction
How often should pregnant diabetics be seen in clinic?
Every 1-2 weeks
When should ultrasound scanning be made available to pregnant diabetics?
Weeks: 20, 28, 32, 336
When should retinopathy be rechecked for?
First check should be in first clinic
16-20 weeks
28 weeks
At the first antenatal and 28 week clinic, what eGFR should warrant referral to a nephrologist?
<45
When should women with diabetes prior to pregnancy be advised to give birth?
Advise pregnant women with type 1 or type 2 diabetes and no other complications to have an elective birth by induction of labour, or by elective caesarean section if indicated, between 37+0 weeks and 38+6 weeks of pregnancy.
When should women with gestational diabetes be advised to give birth?
Advise women with gestational diabetes to give birth no later than 40+6 weeks, and offer elective birth (by induction of labour, or by caesarean section if indicated) to women who have not given birth by this time.
Which antihyperglycaemic medications are permitted in breastfeeding?
metformin and glibenclamide
Breastd=feeding carries an increased risk of what to the pregnant mother?
Hypoglycaemia
What is foetal hyperinsulinemia? What issues does it lead to? How are these managed?
Hyperinsulinemia in neonates can be the result of a variety of environmental and genetic factors. If the mother of the infant is a diabetic, and does not properly control her blood glucose levels, the hyperglycemic maternal blood can create a hyperglycemic environment in the fetus. To compensate for the increased blood glucose levels, fetal pancreatic beta cells can undergo hyperplasia. The rapid division of beta cells results in increased levels of insulin being secreted to compensate for the high blood glucose levels. Following birth, the hyperglycemic maternal blood is no longer accessible to the neonate resulting in a rapid drop in the newborn’s blood glucose levels. As insulin levels are still elevated this may result in hypoglycemia. To treat the condition, high concentration doses of glucose are given to the neonate as required maintaining normal blood glucose levels. The hyperinsulinemia condition subsides after one to two days.
What is the pathophysiology of gestational diabetes?
- Insulin is deregulated through increased levels of growth hormone, progesterone, placental lactogen (HPL) and cortisol.
- There is usually a reflective increase in insulin
- In patients with gestational diabetes, this does not occur.
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NAME 7 RISK FACTORS FOR DEVELOPING GESTATIONAL DIABETES.
- Previous gestational diabetes
- Macrosomia
- Maternal obesity
- Family history of T2DM
- Polyhydramnios
What are the criteria to diagnose gestational diabetes?
A fasting plasma glucose level of 5.6 mmol/litre or above or
A 2‑hour plasma glucose level of 7.8 mmol/litre or above.
