Diabetes in Pregnancy

Question 1

What are the risks of poorly controlled blood glucose in pregnancy?

Answer 1

miscarriage
congenital malformation
still birth
neonatal death

Question 2

What advice should you given to diabetic women who are planning pregnancy?

Answer 2

Diet, weight & exercise
risks of hypoglycaemia
Nausea and vomiting effect of BG
Risk of large babies - birth trauma, induction & c section
assess diabetic retinopathy
assess diabetic nephropathy
importance of controlling maternal BG during labour
temporary neonatal health problems
risk of child developing obesity or diabetes later in life

Question 3

What advice would you give regarding folic acid?

Answer 3

Take 5mg and day from starting to plan pregnancy until 12 weeks gestation

Question 4

How often should women with diabetes who are trying to conceive have their HbA1c level monitored?

Answer 4

Monthly

Question 5

What is the preconception advice around ketoaemia for type 1 diabetics?

Answer 5

Offer women blood ketone testing strips and meter so they can test if they become hyperglycaemic or unwell

Question 6

What are the target blood glucose levels for diabetic women preconception?

Answer 6

Fasting plasma glucose 5-7 mmmol/L on waking

Plasma glucose 4-7 mmol/l before meals and other times of day

Question 7

What is the target HbA1c level for diabetic women preconception?

Answer 7

48 mmol/L

Question 8

At what HbA1c level and above would you advise diabetic women not to get pregnant?

Answer 8

86 mmol/L

Question 9

Which diabetic medicines are considered safe during preconception and pregnancy?

Answer 9

Metformin for blood glucose lowering agents

Long-acting insulin - isophane insulin AKA NPH insulin is first line insulin therapy

Question 10

Which medicines should be discontinued or replaced during preconception and pregnancy?

Answer 10

ACEi and Angiotensin 2 receptor antagonists - find alternative anti-hypertensives
Discontinue statins