Diabetes in Pregnancy Flashcards
Gestational Diabetes (GDM)
- Abnormal glucose tolerance first recognized at any time during the pregnancy.
- Diabetes diagnosed in the 2nd & 3rd trimester of the pregnancy.
Pre-existing / Pregestational Diabetes
Type 1 or 2 diabetes diagnosed before conception.
Prevalence of Gestational Diabetes is increasing, likely due to?
Increase in mean maternal age & BMI (increasing obesity).
Short term risks associated with GDM
- hypertensive disorders (e.g. Preeclampsia)
- fetal macrosomia (large baby for gestational age)
- birth trauma to mother or newborn
- operative delivery (caesarian, assisted vaginal birth)
- perinatal mortality
- polyhydramnios (too much amniotic fluid)
- fetal/neonatal hypertrophic cardiomyopathy
- neonatal respiratory problems & metabolic complications (hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia)
Long term risks associated with GDM in mothers
Increased risk of type 2 diabetes & cardiovascular diseases.
Long term risks associated with GDM in adolescent & adult offspring
- increased risk of obesity
- diabetes (abnormal glucose tolerance)
- hypertension
Individuals at risk of developing GDM
- Personal history of impaired glucose tolerance, impaired fasting glucose & GDM in previous pregnancy (40% risk of recurrence).
- Family history of diabetes - esp 1st degree relative
- Pre-pregnancy BMI >30kg/m2
- Older maternal age (especially >40yrs)
- Hispanic American, Native American, South or East Asian, Pacific Islander, African American.
- Polycystic ovary syndrome
- Previous birth weight >4kg or >4000g
Fetal complications - short term
- Spontaneous abortion
- Macrosomia (enlarged baby for gestational age)
- Polyhydramnios (excess amniotic fluid)
- Fetal demise (fetal death)
- Prematurity
- Congenital anomalies
- Respiratory distress syndrome
- Hypoglycemia
- Hyperbilirubinemia
- Polycythemia
- Hypocalcemia
- Hypomagnesemia
Fetal complications - Long term
- Adult obesity
- Type 2 diabetes
- Neurodevelopment delays
Maternal complications
- Ketoacidosis
- Glycosuria
- Hyperglycemia
- Polyhydramnios
- Hypertension / Preeclampsia
- Infections (e.g. UTIs)
- Increased risk operative delivery
- Post partum depression
- Development of type 2 diabetes
- Uterine atony (failure of the uterus to contract following delivery)
Clinical features of GDM - 4 Ps
- Polyuria (frequent urination)
- Polydypsia (increase in thirst)
- Polyphagia (increase hunger)
- Paraesthesia (numbness & tingling)
Polynesian
What is the diagnostic test for diabetes?
75g Oral Glucose Tolerance Test (OGTT)
Explain the diagnostic test (OGTT) for diabetes
- It’s performed between 24-28 weeks gestation.
- Patient fasts for at least 8hrs and then takes a fasting blood glucose level. After this, they drink 75g of glucose solution (really sweet), & then a post-prandial glucose level test is done after 2hrs.
- Diabetes if:
Fasting plasma glucose level of >5.6mmol/L
2hr plasma glucose level of >7.8mmol/L
Explain the NICE diagnostic criteria for GDM
NICE - National Institute for Health & Care Excellence Guidelines
Diagnose GDM if the woman has either:
- a fasting plasma glucose level of >5.6mmol/L
- 2hr plasma glucose level of >7.8mmol/L
What is the main goal for the management of GDM / Diabetes?
To achieve good glycemic control before pre-conception, during pregnancy & after pregnancy. This improves perinatal outcome.
