Diabetes in Pregnancy

Question 1

What triggers diabetes during pregnancy?

Answer 1

Reduced insulin sensitivity

This condition resolves after birth.

Question 2

What are the biggest implications of gestational diabetes?

Answer 2

Macrosomia and neonatal hypoglycaemia

Macrosomia refers to a newborn being larger than average.

Question 3

What risk do women face after pregnancy if they had gestational diabetes?

Answer 3

Higher risk of developing Type 2 Diabetes Mellitus (TIIDM)

This can occur due to underlying insulin resistance.

Question 4

When should women with risk factors be screened for gestational diabetes?

Answer 4

24-28 weeks gestation

Screening is typically done using an oral glucose tolerance test.

Question 5

What conditions warrant testing for gestational diabetes according to NICE 2015?

Answer 5

• Previous gestational diabetes
• Previous macrosomic baby (>4.5kg)
• BMI >30
• Ethnic origin
• Family history of diabetes (first-degree relative)

These factors increase the likelihood of developing gestational diabetes.

Question 6

What is the purpose of the Oral Glucose Tolerance Test?

Answer 6

Screening test for gestational diabetes

It is used for patients with risk factors or symptoms suggesting gestational diabetes.

Question 7

What are the steps in the Oral Glucose Tolerance Test process?

Answer 7

• Measure fasting blood glucose
• Drink 75g glucose
• Measure blood glucose at 2 hours

This process helps determine if a patient has gestational diabetes.

Question 8

What are the normal results for blood glucose levels during the Oral Glucose Tolerance Test?

Answer 8

• Fasting: <5.6
• At 2 hours: <7.8
• Cutoff for gestational diabetes: 5-6-7-8

These values help to diagnose gestational diabetes.

Question 9

What is the management protocol for fasting glucose <7 in gestational diabetes?

Answer 9

• Trial diet and exercise
• Metformin
• Insulin

This approach is taken to control blood sugar levels.

Question 10

What should be done if fasting glucose is >7 in gestational diabetes management?

Answer 10

Insulin + metformin

This combination is used to manage higher blood sugar levels.

Question 11

What is the recommended folic acid dosage for women with pre-existing diabetes during pregnancy?

Answer 11

5mg from preconception to 12 weeks gestation

Folic acid is crucial for fetal development.

Question 12

What is the aim for women with pre-existing diabetes prior to pregnancy?

Answer 12

Good glycaemic control

This helps reduce risks during pregnancy.

Question 13

What are some risks to babies born to mothers with diabetes?

Answer 13

• Neonatal hypoglycaemia
• Polycythaemia
• Jaundice
• Congenital heart disease
• Cardiomyopathy

These conditions can affect newborn health.

Question 14

What are clinical signs of hypoglycaemia in the newborn?

Answer 14

• Sweating
• Feeding difficulties
• Weak or high-pitched cry
• Tremors
• Hypothermia

These signs require immediate attention.

Question 15

What should be done if a newborn’s glucose levels remain low?

Answer 15

Nasogastric feeding or IV glucose

Timely intervention is necessary to prevent complications.

Question 16

What is the follow-up test recommended for gestational diabetes?

Answer 16

Fasting glucose ≥ 6 weeks postnatal

This helps assess the mother’s glucose levels after childbirth.

Question 17

What is the management for fasting glucose >6 with macrosomia or other complications?

Answer 17

Insulin + metformin

This management strategy is crucial for controlling blood sugar levels.