Diabetes in pregnancy

Question 1

gestational diabetes (3)

Answer 1

• Placental progesterones and hPL produce insulin resistance in the mother, meaning more nutrients diverted to foetus
• If mother is insulin resistant before pregnancy, developing further insulin resistance will raise blood glucose too high and result in gestational diabetes

-3rd trimester

Question 2

Mother has too much glucose - transfers to feotus= (4)

Answer 2

Macrosomia (>90th centile for size, birth weight >4kg)

Problems with delivery

Polyhydramnios (too much fluid around baby)

Interuterine death

Question 3

Macrosomia (3)

Answer 3

• Maternal hypoglycaemia is transferred across the placenta, resulting in foetal hyperglycaemia
  -causes foetal hyperinsulinaemia - insulin is a MAJOR growth factor
• After birth, the baby takes a while to downregulate the hyperinsulinaemia which puts the baby at risk of neonatal hypoglycaemia

Question 4

Complications in neonate (4)

Answer 4

• Respiratory distress due to immature lungs
• Hypoglyaemia/hypocalcaemia → fits
• CNS defects - anencephaly, spina bifida
• Skeletal abnormalities - caudal regression syndrome

Question 5

Investigations- as easy as 5678

Answer 5

Diagnosis of GDM is based on a 75g OGTT:

Fasting blood glucose level fasting glucose ≥5.6 mmol/L

2-hour plasma glucose level 2-hour glucose ≥7.8 mmol/L

Question 6

GDM management (3)

Answer 6

• Lifestyle= -
  Pre meal <4-5.5 mmol
  2 hr post meal <6-6.5 mmol/
• Metformin
• May need insulin

Question 7

T1 and T2DM complications in pregnancy (3)

Answer 7

• Congenital malformation
• Prematurity
• Intra-uterine growth retardation (IUGR)

Question 8

T1 and T2DM management in pregnancy (2)

Answer 8

• Pre-pregnancy counseling
  
  • Good sugar control pre conception to limit risk of congenital malformation

-Folic acid 5mg (not 400ug as in non-DM pregnancy) at least 3 months prior to conception!

Question 9

T1 and T2DM pharmacology in pregnancy (4)

Answer 9

• Consider change from tablets to insulin as some T2DM oral medications are contraindicated in pregnancy
• Regular eye checks (10, 20, 30 weeks gestation) to check for any accelerated retinopathy
• Avoid ACEi and probably avoid statins
  
  • For BP use labetalol, nifedipine, methyldopa
• Start aspirin 150mg at 12 weeks (as in all high risk pregnancies)
  
  • Reduces the risk of pregnancy-induced hypertension