Diabetes in Pregnancy

Question 1

What are the maternal complications of diabetes in pregnancy?

Answer 1

1. Hypoglycaemia unawareness
2. Pre-eclampsia
3. UTI/wound or endometrial infection postnatally

Question 2

What are the foetal complications of diabetes in pregnancy?

Answer 2

1. Miscarriage
2. Malformation related to pre-conception glucose
3. Macrosomia - shoulder dystocia
4. IUGR
5. Polyhydramnios
6. Preterm labour
7. Still birth

Question 3

What is the preconceptual care for pre-existing diabetes?

Answer 3

1. Avoid unplanned pregnancy
2. Aim HbA1c <43 (6.1%), avoid pregnancy if >85 (10%)
3. 5mg folic acid daily for 3 months prior to conception
4. Stop oral hypoglycaemics (except metformin)
5. Stop statins, ACEi/Ang II antagonists (use alternatives)
6. Treat retinopathy prior to pregnancy

Question 4

How much does insulin requirement change in pregnancy?

Answer 4

Increases 300%

Question 5

What is the glucose aim in pre-existing diabetes in pregnancy (fasting and 1-hour post-prandial)?

Answer 5

1. Fasting 3.5-5.5 mmol/L

2. 1-hour post-prandial <7.8 mmol/L

Question 6

What should be prescribed in case of hypoglycaemia and what should you check?

Answer 6

1. GlucoGel and glucagon

2. Ensure partner knows how to use

Question 7

What should be checked in diabetic mothers every trimester?

Answer 7

Renal function and retinal screen

Question 8

What should be prescribed in diabetic mothers to reduce the risk of pre-eclampsia?

Answer 8

Aspirin 75mg OD from 12/40

Question 9

What should be monitored on USS in diabetic mothers?

Answer 9

Foetal growth, every 4 weeks from 28/40

Question 10

When should delivery take place in diabetes mellitus and gestational diabetes mellitus?

Answer 10

1. DM - 38 weeks

2. GDM - 40 weeks (if well controlled)

Question 11

How should pre-conception diabetes regimes be altered for after pregnancy?

Answer 11

1. Should not be changed

2. Resume as before immediately

Question 12

What should you check in the new born baby of a diabetic mother?

Answer 12

1. Glucose

2. Treat hypoglycaemia

Question 13

What risk factors indicate screening for gestational diabetes?

Answer 13

1. Previous large baby (>4.5kg)
2. Unexplained stillbirth
3. 1st degree relative with DM
4. BMI >30
5. Ethnic origin with high prevalence

Question 14

What is the screening tool for gestational diabetes and when does it occur?

Answer 14

1. Fasting glucose or 75g OGTT

2. 24-28 weeks

Question 15

At what range of results if gestational diabetes diagnosed?

Answer 15

1. Fasting >5.6mmol/L

2. 2 hour OGTT >7.8mmol/L

Question 16

What is the treatment in gestational diabetes if fasting glucose is above 7mmol/L?

Answer 16

Treat immediately with metformin and insulin.

Question 17

What is the treatment in gestational diabetes if fasting glucose is between 5.6-7mmol/L?

Answer 17

1. Give glucometer, advise diet and exercise.
2. If after 2 weeks >5.3 before meals/>7.8 after meals then add metformin.
3. If after 2 weeks same still applies, add insulin.

Question 18

When can delivery be aimed for in well controlled gestational diabetes?

Answer 18

Up to term at 40 weeks.

Question 19

What is the protocol for postnatal care of gestational diabetes?

Answer 19

1. Treatment discontinued

2. Fasting glucose at 6 weeks and screen annually.

Question 20

What percentage of mothers with gestational diabetes become type 2 diabetics within the next 10 years?

Answer 20

50%