diabetes in pregnancy

Question 1

effects of pregnancy on diabetes

Answer 1

increased hypos
increased insulin needs
worsening nephro/retinopathy

Question 2

effects of diabetes on pregnancy (maternal)

Answer 2

acute:
hypos
preeclampsia
infection

longer term:
miscarriage
worsening renal + eye disease
inductions + caesareans

Question 3

effects of diabetes on pregnancy (foetal)

Answer 3

macrosomia (→ shoulder dystocia; → polyhydramnios → preterm, cord prolapse)
malformations - cardiac, NTDs, skeletal
hypo at birth
stillbirth

Question 4

risks of macrosomia

Answer 4

baby:
shoulder dystocia
polyhydramnios - poss preterm + cord prolapse (PPP)

mum:
induction or dysfunctional labour
PPH

Question 5

advice to a diabetic lady wanting to get pregnant

Answer 5

advise against if HbA1c > 86
screen for retino + nephropathy
extra folic acid (5mg) 3mo before
switch to insulin or metformin

Question 6

what USS will a diabetic lady need in pregnancy?

Answer 6

routine dating 11-13
routine anomaly 20
from 28wk - 4wklys for macrosomia + polyhydramnios

Question 7

advice + care to a pregnant lady with preexisting diabetes

Answer 7

aspirin 75mg - ↓preeclampsia
monitor BG - fasting, premeal, 1h post, bedtime
meet MDT fortnightly
1st app - retinal + renal check
28wk - retinal check
anaesthetic review
antenatal + 6wk postnatal LMWH (stop at onset of labour)

Question 8

when should diabetic ladies deliver?

Answer 8

by 38 recommended

uncomplicated preexisting - offer elective IOL / caesarean 37 - 38+6 [786] (before if complications / risk shoulder dystocia)

GDM - before 40+6

Question 9

intrapartum care of lady with diabetes + following few hours

Answer 9

T1 or poorly controlled DM - insulin dextrose sliding scale during labour
1st breastfeed in 30min
check neonatal BG 2-4hrly

Question 10

postpartum care of diabetic lady

Answer 10

restart pre-pregnancy dose of insulin or lower if breastfeeding
GDM - stop all antidiabetics

Question 11

advice to a lady who’s had GDM

Answer 11

diet + weight loss to reduce recurrence
offer fasting BG to test for T2
screen annually

Question 12

risks of high BMI on pregnancy (mum and foetus)

Answer 12

mum:
preeclampsia
GDM
VTE
hard to site regional anaesthetic/anaesthetic probs

baby:
congenital malformations
macrosomia (+ assoc risks - PPP, SD; PPH)

Question 13

postpartum risks of high BMI pregnancy

Answer 13

PPH
wound infection
VTE

Question 14

advice to high BMI lady wanting to get pregnant

Answer 14

lose weight + eat healthier - aim BMI < 30

give more folic acid + vit D

Question 15

GDM - diagnosis, mgmt + BG targets

Answer 15

GTT - 28wk
mgmt - diet ± metformin ± insulin
targets - fasting 3.5 - 5.5, postmeal < 7.1

Question 16

risk factors for shoulder dystocia

Answer 16

macrosomia, diabetes, high BMI
previous occurrence
IOL, instrumental, epidural

Question 17

screening for gestational diabetes - when + how

Answer 17

prev hx - OGTT at booking. if normal - at 24-28

if RFs - OGTT at 24-28

Question 18

gestational diabetes diagnostic thresholds

Answer 18

fasting 5.6+

2h 7.8+

Question 19

BG targets for all diabetes in pregnancy

Answer 19

fasting - 5.3
1h postmeal - 7.8
2h postmeal - 6.4