Diabetes in preg Flashcards
1
Q
Pre-conception
A
- Wt loss if BMI>27
- Folic acid 5mg/day
- Retinopathy and nephropathy assessment
- Monthly HbA1c
- Medication- only metformin and insulin
- Advise contraception if BMs not well controlled (HbA1c>86) , inc risks in preg
2
Q
BM target for T1DM (pre-preg)
A
Fasting- 5-7mmol/L
Other times- 4-7 mmol/L
3
Q
Testing in preg, timing
A
Prev GDM- OGTT at booking and 24-28weeks
RF- OGTT at 26 weeks
4
Q
RF for diabetes
A
Ethnicity
BMI>30
Prev LGA>4.5kg
Fhx- 1st deg relative w DM
Glycosuria
5
Q
OGTT BM for diagnosis
A
Fasting >5.6 mmol/L
2h >7.8 mmol/L
6
Q
Mx of GDM
A
Testing 4 x/day
If fasting <5.6-7 mmol/L
- Diet and exercise
If >7mmol/L or <7 but macrosomia or poly:
- Metformin
- Insulin
- Counsel women on risks of GDM
7
Q
Target BMs w GDM
A
- Fasting <5.3
- 1h post meal <7.8
- 2h post meal <6.4
8
Q
HbA1c testing
A
- At booking and 2nd/3rd T for all women w diabetes
- GDM- at diagnosis (incase of pre-existing DM)
9
Q
Retinal assessment
A
- At booking (if not done in last 3 months)
- If retinopathy- repeat at 16-20 weeks
- If normal- repeat at 28 weeks
10
Q
Renal assessment
A
- At booking, if not done in last 3/12
- Refer to nephrologist if-
Cr >120
Urine Albumin:Cr ratio >30
Protein >0.5g/day
11
Q
AN care/follow up
A
- Diabetes clinic
- Aspirin
- 4 weekly scans (more if needed)
12
Q
Delivery
A
- T1/T2 DM- IOL at 37-39 weeks
- GDM- IOL at term +6
Sooner if other complications
13
Q
BM in labour
A
- Hourly BM, maintain between 4 and 7 mmol/L
14
Q
Baby
A
- 24h monitoring
- Early feed
- Feeds every 2-3h
- Check baby’s BM after feed
15
Q
PN, if GDM
A
- Stop medications
- Fasting glucose at 6 weeks w GP
<6.9- high risk of DM
>7- likely to have T2DM - Counsel about inc risk of DM
- Yearly HbA1c
