Diabetes In Pregnancy

Question 1

What proportional of diabetes in pregnancy are gestational, type 1 and type?

Answer 1

GDM - 87.5%
Type 1 - 7.5%
Type 2 - 5%

Though GDM/Type 2 increasing due to BMI

Question 2

Which ‘diabetic’ hormones increase in the 2nd half of pregnancy?

Answer 2

Cortisol
Glucagon
Human Placental Lactogen

Question 3

How much do insulin requirements increase in normal pregnancy?

Answer 3

By 30-40%

Question 4

What is the rate of congenital malformations in the normal population?

Answer 4

2.1%

Question 5

What is the rate of congenital malformations in IDDM?

Answer 5

5-10%

Up to 40% if HbA1C is >= 133.9
Almost background risk (2%) if HbA1C <= 38

Question 6

What are the most common congenital malformations in diabetics and which one is specific to DM?

Answer 6

Cardiovascular malformations most common

Sacral Agenesis is uncommon but 300x more in DM

Question 7

What is the incidence of premature delivery in IDDM?

Answer 7

20%

Question 8

How much more common is PET in IDDM?

Answer 8

x2

Question 9

What is the incidence of polyhydramnios in IDDM?

Answer 9

15%

Question 10

What is the rate of neonatal hypoglycaemia in IDDM?

What other biochemical abnormalities are seen?

Answer 10

18-49%

Hypocalcaemia and hypomagnesaemia - seizures

Question 11

What is the increase in RDS in IDDM?

Answer 11

x6

Back to baseline if good control at term

Question 12

By how much does pregnancy increase risk of retinopathy (independently)?

Answer 12

x2

Question 13

What is the mortality for women with previous MI or infarction during pregnancy?

Answer 13

> 50%

Question 14

What are the target plasma glucose levels in IDDM?

Answer 14

Fasting <5.3
1 hour <7.8 or
2 hour <6.4

Question 15

When should IDDM be delivered by?

Answer 15

37-38+6

Question 16

What are the benefits of metformin during pregnancy in PCOS?

Answer 16

Contentious but:
Decrease in T1 miscarriage
Weight loss
Reduced incidence of GDM

Question 17

What are the risk factors for GDM?

Answer 17

Previous GDM (test early in pregnancy)
First degree relative with DM
BMI >30
Previous big baby >=4.5kg
Ethnic origin (South Asian, Black Caribbean, Middle East)

Also test if glycosuria, polyhydramnios

Question 18

What are the cut off BMs for diagnosing GDM?

Answer 18

Fasting 5.6
2 hourly 7.8

If fasting >7 - start on treatment immediately without attempting diet control alone

Question 19

How many women with GDM on oral hypoglycaemics will require additional insulin?

Answer 19

20-30%

Question 20

When should women with GDM be delivered by?

Answer 20

If diet control - by 40+6

Consider earlier if fetal/maternal complications

Question 21

How many women with GDM become diabetic within 15 years?

Answer 21

50%

Question 22

What is the postnatal follow up for women with GDM?

Answer 22

6/52 fasting BM or 13/52 HbA1C

Question 23

What is the preterm delivery rate in diabetics compared to normal controls?

Answer 23

36% vs 7%

Question 24

What is the Caesarean section rate in diabetics compared to normal controls?

Answer 24

67% vs 22%

Question 25

What is the rate of BW >= 4kg in diabetics compared to normal controls?

Answer 25

21% vs 11%

Question 26

What is the rate of shouder dystocia in diabetics compared to normal controls?

Answer 26

8% vs 3%

Question 27

What is the increase in Erb's palsy in diabetics compared to normal controls?

Answer 27

10x

Question 28

What is the increase in stillbirth in diabetics compared to normal controls?

Answer 28

x5

Question 29

What is the increase in perinatal mortality in diabetics compared to normal controls?

Answer 29

3x

Question 30

what percentage of all pregnancies are affected by gestational diabetes?

Answer 30

5%

Question 31

What is the recommendation re: insulin and breastfeeding in type 1 DM?

Answer 31

Reduce prepregnancy insulin dose by 25% if breastfeeding

Question 32

What % of GDM patients will ultimately require insulin?

Answer 32

20-30%