Diabetes In Pregnancy Flashcards
What proportional of diabetes in pregnancy are gestational, type 1 and type?
GDM - 87.5%
Type 1 - 7.5%
Type 2 - 5%
Though GDM/Type 2 increasing due to BMI
Which ‘diabetic’ hormones increase in the 2nd half of pregnancy?
Cortisol
Glucagon
Human Placental Lactogen
How much do insulin requirements increase in normal pregnancy?
By 30-40%
What is the rate of congenital malformations in the normal population?
2.1%
What is the rate of congenital malformations in IDDM?
5-10%
Up to 40% if HbA1C is >= 133.9
Almost background risk (2%) if HbA1C <= 38
What are the most common congenital malformations in diabetics and which one is specific to DM?
Cardiovascular malformations most common
Sacral Agenesis is uncommon but 300x more in DM
What is the incidence of premature delivery in IDDM?
20%
How much more common is PET in IDDM?
x2
What is the incidence of polyhydramnios in IDDM?
15%
What is the rate of neonatal hypoglycaemia in IDDM?
What other biochemical abnormalities are seen?
18-49%
Hypocalcaemia and hypomagnesaemia - seizures
What is the increase in RDS in IDDM?
x6
Back to baseline if good control at term
By how much does pregnancy increase risk of retinopathy (independently)?
x2
What is the mortality for women with previous MI or infarction during pregnancy?
> 50%
What are the target plasma glucose levels in IDDM?
Fasting <5.3
1 hour <7.8 or
2 hour <6.4
When should IDDM be delivered by?
37-38+6
What are the benefits of metformin during pregnancy in PCOS?
Contentious but:
Decrease in T1 miscarriage
Weight loss
Reduced incidence of GDM
What are the risk factors for GDM?
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
What are the cut off BMs for diagnosing GDM?
Fasting 5.6
2 hourly 7.8
If fasting >7 - start on treatment immediately without attempting diet control alone
How many women with GDM on oral hypoglycaemics will require additional insulin?
20-30%
When should women with GDM be delivered by?
If diet control - by 40+6
Consider earlier if fetal/maternal complications
How many women with GDM become diabetic within 15 years?
50%
What is the postnatal follow up for women with GDM?
6/52 fasting BM or 13/52 HbA1C
What is the preterm delivery rate in diabetics compared to normal controls?
36% vs 7%
What is the Caesarean section rate in diabetics compared to normal controls?
67% vs 22%
What is the rate of BW >= 4kg in diabetics compared to normal controls?
21% vs 11%
What is the rate of shouder dystocia in diabetics compared to normal controls?
8% vs 3%
What is the increase in Erb’s palsy in diabetics compared to normal controls?
10x
What is the increase in stillbirth in diabetics compared to normal controls?
x5
What is the increase in perinatal mortality in diabetics compared to normal controls?
3x
what percentage of all pregnancies are affected by gestational diabetes?
5%
What is the recommendation re: insulin and breastfeeding in type 1 DM?
Reduce prepregnancy insulin dose by 25% if breastfeeding
What % of GDM patients will ultimately require insulin?
20-30%
