Diabetes in Pregnancy

Question 1

How can Pregestational DM be affected by pregnancy ?

Answer 1

preexisting type 1 or 2 DM
- changes in hormones due to pregnancy can affect glycemic control and vascular complications
- insulin needs increase throughout pregnancy and return to pre-pregnant levels within 7-10 days post birth (non-breastfeeding moms) or insulin needs can decrease during breastfeeding

Question 2

Why is it important for a mother with diabetes to have controlled their sugars before pregnancy ?

Answer 2

uncontrolled glucose can cause congenital heart defects
- need tight control 3 months before pregnancy

Question 3

Does insulin cross the placenta ?

Answer 3

no it doesn’t
- so any insulin mom takes doesn’t pass onto baby
- baby makes their own insulin which is like a growth hormone for baby and causes them to increase in weight

Question 4

How far along in pregnancy does the fetus start to secrete it’s own insulin ?

Answer 4

10th week

Question 5

What are some maternal risks from diabetes ?

Answer 5

• preeclampsia (HTN)
• hydramnios (too much amniotic fluid)
• infections
• hyperglycemia & DKA
• hypoglycemia
• C-section or operative vaginal delivery (since baby will be chunky)

Question 6

What are some fetal risks from diabetes ?

Answer 6

• miscarriages/stillbirth
• IUFD (intrauterine fetal demise)
• congenital malformations
• macrosomia (big baby from insulin secretion)
• hypoglycemia after birth (once baby is born it’s still secreting insulin but aren’t getting glucose from mom anymore to counteract that insulin)

Question 7

What is some fetal surveillance for someone with preexisting diabetes in the 1st trimester ?

Answer 7

initial ultrasound (US) to determine EDC, then q4-6 wks to assess fetal growth and anomalies

Question 8

What is some fetal surveillance for someone with preexisting DM for 16-18 wks ?

Answer 8

AFP (alpha fetal protein) since they have a higher risk of neural tube defects

Question 9

What is some fetal surveillance for someone with preexisting DM for 20-22 wks ?

Answer 9

fetal echocardiogram (in addition to normal head to toe assessment US) to assess for congenital heart defects

Question 10

What is some fetal surveillance for someone with preexisting DM at 28 wks ?

Answer 10

fetal kick counts

Question 11

What is some fetal surveillance for someone with preexisting DM at 32 weeks ?

Answer 11

NST at least 2x/week
- BPP if NST non-reaction
- also for 40 wks in women with good diet controlled glucose

Question 12

Why do you have to be reclassified for gestational DM ?

Answer 12

to ensure that the diabetes was only gestational and not type 2 that we happened to catch
- 6-12 wks after pregnancy

Question 13

At how many weeks do you screen for gestational diabetes ?

Answer 13

24-28 with glucola
- maybe sooner if strong risk factors for DM
- increase risk for recurrent GDM in future pregnancies

Question 14

For the glucose tolerance test, what is a positive and negative result ?

Answer 14

• positive: greater then or equal to 130-140
• negative: less then 130-140

Question 15

What happens next if your 1 hr glucose tolerance test is positive ?

Answer 15

do the 3 hr glucose tolerance test
- have to met 2 or more of the expected values to be diagnosed positive with gestational DM