Diabetes in pregnancy

Question 1

Define diabetes in pregnancy.

Answer 1

Pre-existing or new onset diabetes in pregnancy.

Question 2

Explain the aetiology of diabetes in pregnancy.

Answer 2

Pre-existing Type 1 or Type 2 DM

Gestational DM: Altered glucose tolerance in pregnancy only

Question 3

What are the risk factors for diabetes in pregnancy?

Answer 3

Maternal age, ethnicity South Asian/Caribbean, obese, smoking, PCOS, previous macrosomic baby (i.e. Beckman-Widemann Syndrome)

Question 4

Summarise the epidemiology of diabetes in pregnancy.

Answer 4

2-5% pregnancy, GDM accounts for 90% of DM in pregnancy.

Question 5

Recognise the presenting symptoms of diabetes in pregnancy. Recognise the signs of diabetes in pregnancy on physical examination

Answer 5

Usually asymptomatic and picked up on screening

(Fasting plasma glucose level >5.6 mmol/L, or 2-hour plasma glucose level >7.8 mmol/L)

Question 6

Identify appropriate investigations for diabetes in pregnancy and interpret the results.

Answer 6

Fundal height abnormal (polyhydramnios and macrosomia)

Fasting plasma glucose level >5.6 mmol/L, or 2-hour plasma glucose level >7.8 mmol/L

Question 7

Generate a management plan for diabetes in pregnancy.

Answer 7

Pre-existing

• Pre- Conceptual optimisaiton of glucose control
  Medical optimisaiton of diet, consider converting oral hypoglycaemic to insulin.
  Pregnancy: CBG monitoring strict.
  Delivery: sliding scale in labour
  Post partum: return to pre-pregnancy medicaitons and doses.

GDM:

• Diet control. If persisting, insulin.
• Pregnancy/delivery: as for pre existing.
• Postpartum: stop insulin, FBG 6/52 post partum

Question 8

Identify the possible complications of diabetes in pregnancy and its management. Summarise the prognosis for patients with diabetes in pregnancy.

Answer 8

• Maternal: Progression of pre existing microvascualt (renal, eye, neuropathy) complications of diabetes.
• Miscarriage, pre eclampsia, operative delivery requirement.
• Fetal/neonatal: congenital abnormalities (if pre-existing), fetal death, polyhydramnios, polycythaemia, macrosomia, RDS, neonatal hypoglycaemia, neonatal jaundice.

Prognosis depends on control. GDM 70% recur in future pregnancies and mothers are at an increased risk of developing diabetes in the future.