Diabetes In Pregnancy

Question 1

How is glucose metabolism altered within pregnancy?

Answer 1

Due to impaired glucose tolerance (insulin resistance) due to steroid like pregnancy hormones antagonising insulin. These are often counterbalanced by increased maternal insulin production - however those with pre-existing diabetes/gestational diabetes have an insufficient insulin response

Question 2

Name four placental hormones responsible for impairing glucose metabolism?

Answer 2

Glucagon
Cortisol
Human placental lactogen
Progesterone

Question 3

At what level do kidneys excrete glucose in a NON-pregnant individual?

Answer 3

11.0mmol/L - if pregnant threshold decreases and glycosuria more common at ‘physiological’ glucose levels

Question 4

Define gestational diabetes?

Answer 4

Carbohydrate intolerance resulting in hyperglycaemia with onset during pregnancy - which may/may not resolve after

Question 5

Name six risk factors associated with gestational diabetes?

Answer 5

High BMI (35+)
Previous GDM (80%)
Family Hx
Previous macrosomic baby (>4.5kg)
Ethnicity (S/E Asian//M.E//Black Caribbean)
Previous unexplained uterine death

Question 6

Under what conditions and when is a glucose tolerance test offered?

Answer 6

Maternal risk factor
If on two separate occasions glycosuria is identified
GTT offered 26-28 weeks (previous GDM offered at 18)

Question 7

What are the values of normal glycaemic control?

Answer 7

4-8 mmol/L

Question 8

What effect might pregnancy have on insulin-dependent diabetics?

Answer 8

Synthetic insulin would be affected due to the antagonistic hormones of pregnancy (diabetogenic) - therefore the requirements of insulin dosage increasesto overcome this

Question 9

What can be done if a person takes on too much insulin during pregnancy?

Answer 9

Insulin antidote =

BM

Question 10

Name 7 maternal complications of diabetes within pregnancy?

Answer 10

Pre-eclampsia
Prolonged labour
Increased UTI
Increased risk of instrumental and C-section delivery
PPH
Nephropathy (U+E commonly checked)
Retinopathy - eyes checked at booking scan and 28 weeks)

Question 11

Name 6 foetal complications associated with diabetes within pregnancy?

Answer 11

Congenital abnormalities (NTD)
Pre-term labour
Macrosomia - via raised foetal blood glucose levels = hyperinsulinaemia = fat deposition = XS growth = increased urine output = polyhydramnios
IUGR
Stillbirth/intra-uterine death

Question 12

Describe the management of diabetes within pregnancy including targets for HbA-1c and BM?

Answer 12

Education
Pre-conceptual care - folic acid boosted to 5mg/day
Aspirin 75mg prophylaxis for PET reduction @ 12wks
HbA-1c target -

Question 13

Why is close neonatal monitoring following birth vital?

Answer 13

Due to the accustomised high levels of glucose = predisposed hyper-insulinaemic state the neonate commonly develops HYPOglycaemia following birth
Therefore early feeds are vital
Polycythaenia and neonatal jaundice are more common in this state also