Diabetes in Pregnancy Flashcards
Why does blood glucose need to be carefully monitored in pregnancy?
Insulin demand increases
What is the acronym for complications caused by diabetes in pregnancy?
SMASH
What is SMASH
S - shoulder dystocia M - macrosomia A - amniotic fluid increase (polyhydramnios) S - stillbirth H - hypertension/hyperglycaemia
What might uncontrolled diabetes cause in the 1st trimester?
Congenital abnormality
Spontaneous abortion
What might uncontrolled diabetes cause in the 2nd trimester?
Prematurity risk
Miscarriage risk
What might uncontrolled diabetes cause in the 3rd trimester?
Polyhydramnios
Pre-ecclampsia
Still birth
Macrosomia/growth retardation
What is the pathology of macrosomia in diabetes in pregnancy?
Glucose crosses placenta and enters foetal circulation
Stimulates release of insulin
Hyperinsulinaemia activates IGF-1
IGF-1 stimulates growth
Remember insulin is the most important growth factor at this stage
What is pre-conceptive management of diabetes?
Tight glycaemic control
Folic acid
Avoid vit A
Retinal/renal assessment
What should be done to the insulin dose in diabetes in pregnancy?
Increase insulin dose
Pharma management of diabetes in pregnancy?
Antidiabetics are okay to use
What is good for use in hypos in pregnancy?
Glucagon injections
What must be monitored closely in diabetics who are pregnant?
Retinal/renal assessments
Ketone level
Infections!!
What is the labour protocol for diabetics?
INDUCE
If macrosomia –> c section
How is blood glucose maintained during labour?
Insulin-dextrose infusion
Why does blood glucose need help in labour?
CORTISOL RELEASE
Cortisol causes insulin resistance and increased gluconeogenesis