diabetes in pregnancy Flashcards
what should be given to diabetic during pregnancy and pre conception
folic acid 5mg
why is glycosuria common in pregnancy unrelated to DM
GFR increases and tubular glucose reabsorption decreases
maternal complications DM in pregnancy
hydramnios, pre term, still birth, pre eclampsia, miscarriage
fetal complications DM in pregnancy
malformation rates higher, macrosomia, growth restriction
neonatal risks DM
hypoglycaemia, RDS, decr Ca, decr Mg, polycythaemia
which oral hypoglycaemic can be used in pregnancy
metformin
aims fasting glucose
3.5-5.9
aims post prandial (1h) glucose
7.8
what should you exclude if the patient is unwell
DKA
what HbA1c should you not be getting pregnant
> 10% as the risk of malformation is so high
what type of malformation are you at risk of
cardiac and neural tube defect, skeletal abnormalities
what does the placenta secrete that has an anti insulin effect
lactogen, progesterone, HCG, cortisol, cytokines
what is the child at more risk of
adult obesity, glucose intolerance in childhood1
scans in diabetic patient
dating, anomaly, growth scan at 34 weeks
when is delivery aimed for
elective delivery at 38 weeks
what causes fetal hypo
maternal hyper
duration of labour to allow for vaginal delivery
12 hours1
what should you give the evening before induction
insulin
what do you need to give during labour1
1L glucose with insulin via pump
what drugs can be taken and breastfeeding
metformin, glibenclamide
what is the OGTT in gestational
> 7.8
what % pregnancies have gestational D
3%
why would you screen for GDM
prev GDM, BMI >30, FHx, prev baby >4.5kg, high risk area
if GDM not controlled by diet/exercise what would you prescribe
metformin, glibenclamide, insulin
what % GDM develop DM
50%
when to check fasting glucose postpartum in GDM
6 weeks
