Diabetes in pregnancy Flashcards

1
Q

If a woman has preexisting type 1 or type 2 diabetes at the commencement of care, what is the responsibility of the midwife with regard to consultation and referral?

A

C refer

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2
Q

If a woman at the commencement of care presents with a history of gestational diabetes in a previous pregnancy, what is the responsibility of the midwife with regard to consultation and referral?

A

A discuss

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3
Q

If a woman develops gestational diabetes during pregnancy what is the responsibility of the midwife with regard to consultation and referral: if it is diet controlled? if she requires insulin?

A

if diet controlled - B consult

if requiring insulin - C refer

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4
Q

If a woman has a BMI 35 at the commencement of care, what is the responsibility of the midwife with regard to consultation and referral?

A

B consult

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5
Q

If a woman has a BMI >40 at the commencement of care, what is the responsibility of the midwife with regard to consultation and referral?

A

C refer

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6
Q

What is gestational diabetes?

A

any degree of glucose intolerance with onset or first recognition in pregnancy

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7
Q

What is the incidence of gestational diabetes?

A

GDM affects 8-10% of pregnancies in australia

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8
Q

When is GDM usually tested for?

A

routinely at 24-28 weeks gestation
early for high risk women at 12-16 weeks
at 6-8 weeks postpartum in women diagnosed with gestational diabetes

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9
Q

What are the risk factors for GDM?

A
  • previous GDM
  • previous stillbirth/FDIU
  • ethnicity (indigenous australian, pacific islander, indian, SE Asian, middle eastern, maori, afro-carribean
  • age > 40
  • first degree relative with insulin dependent diabetes
  • BMI>35
  • previous macrosomia (>4500g)
  • polycystic ovarian syndrome
  • medications (corticosteroids, antipsychotics)
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10
Q

What 4 tests may be used in screening for GDM?

A
  • oral glucose tolerance test (diagnostic)
  • non fasting plasma glucose
  • HbA1c (not reimbursed by medicare)
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11
Q

Criteria for diagnosis of GDM with a GTT

A

Fasting glucose >5.1 mmol/L
and/or
2h glucose >8 mmol/L
values vary according to local protocols

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12
Q

What is the procedure for a GTT?

A
  • fasting for 10-12 hours
  • baseline plasma glucose measured
  • 75g glucose drunk within 5 mins
  • plasma glucose measured at 1 hour and 2h
  • no food, smoking, drinks other than water or exercise during test
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13
Q

What blood glucose levels should be targeted (fasting, 1 hour and 2 hour post meal) in diet controlled GDM?

A
  • fasting
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14
Q

What strategies are common in managing GDM antenatally?

A
  • modification of diet
  • regular exercise
  • home blood glucose monitoring
  • increased frequency of antenatal visits
  • interdisciplinary team (midwife, obstetrician, diabetes educator, dietition, other specialists)
  • insulin
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15
Q

What are the associated risks of gestational diabetes?

A
  • polyhydramnios
  • preeclampsia
  • C/S
  • PPH
  • perinatal death
  • macrosomia (shoulder dystocia, perineal trauma)
  • birth trauma
  • neonatal hypoglycaemia, hypocalcaemia, magnesaemia
  • respiratory distress syndrome
  • hyperbilirubinaemia
  • neonatal polycythaemia
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16
Q

What long term risks exist for women that have had gestational diabetes?

A

50% risk of developing type 2 DM within 20 years

17
Q

What drugs may be used to treat women with gestational diabetes that isn’t controlled sufficiently with diet?

A
  • insulin
  • metformin
  • glibenclamide (caution)
18
Q

What are the postnatal recommendations for women with gestational diabetes?

A

GTT at 6-12 weeks postpartum

diabetes testing 1-2 yearly

19
Q

List 5 important considerations providing labour care for women with GDM?

A
  • timing of birth (some facilities induce, c/s at 38-39/40, particularly if macrosomic, persistant hyperglycaemic or other complications)
  • glucose levels in labour
  • fetal monitoring (? continuous CTG in labour for GDM on insulin, blood glucose outside optimal range or ? macrosomic)
  • ? shoulder dystocia
  • active management of third stage
20
Q

List 4 means of assessing fetal wellbeing where mum has GDM?

A
  • fetal movements
  • fundal height
  • ultrasound
  • regular CTG if IUGR or macrosomia
21
Q

What are the three different types of diabetes?

A
  • type 1 insulin deficient
  • type 2 insuline resistant
  • gestational
22
Q

How do the normal physiological changes of pregnancy usually change insulin requirements?

A
  • usually fall in first trimester
  • rise in second and third trimesters
  • return quickly to prepregnancy after birth
23
Q

What is the mode of action for metformin?

A
  • reduces insulin resistance

- reduces hepatic glucose production, decreased absorption of glucose and increased peripheral uptake of glucose

24
Q

How safe is use of metformin in pregnancy?

A
  • important to talk to doctor before considering stopping treatment
  • evidence suggests that metformin may increase the chances of conception for women with PCOS, women who continue taking metformin in the first trimester may also have a lower risk of miscarriage, may reduce risk of developing gestational diabetes
  • category C - insufficient evidence, no evidence of adverse effects on baby or increased risk of congenital abnormalities
  • appears to be safe in breastfeeding women
25
Q

What other medicines interact with insulin?

A
decrease insulin requirements
- oral hypoglycaemic agents
- monoamine oxidase inhibitors
- non selective beta adrenergic blockers
- ACE inhibitors
- salicylates
- anabolic steroids
- quinine
- sulphonamides
increase insulin requirements
- oral contraceptives
- glucocorticoids
- thyroid hormones
- sympathomimetics
- nicotinic acid
other
- betablockers
- alcohol