Diabetes in Pregnancy

Question 1

Preconception:

What should be avoided?

How often should HbA1c be done when trying to conceive?

What cardiac meds should be stopped? - 2

What is given to prevent neural tube defects? Dose?

What is the most important thing if managing anyone?

Who else should be involved in their care?

Answer 1

Pregnancy if they can

Monthly

Statins and ACEi/A2RB

Folic acid 5mg

Look at guidelines

Endocrinologist
Diabetic specialist nurse or midwife
Dietician

Question 2

Maternal risks:

Why are they at a higher risk of hypoglycaemia or DKA?

What diabetic complications may it accelerate? - 2

Answer 2

Harder to identify in pregnancy

Retinopathy
Neuropathy

Question 3

Fetal risks:

Antenatal risks?

Birth risks?

Neonatal risks?

Answer 3

Macrosomia
IUGR
Malformation

Shoulder dystocia due to a big baby

Hypoglycaemia
Jaundice

Question 4

Management - Increased diabetic monitoring:

How often do they see their diabetic team?

How is glucose monitored around meals?

Under what value should the HbAC1 be at booking?

Answer 4

Every 2 wks

Before
1 hr after
2 hrs after

<48

Question 5

Management:

Insulin:
- Do requirements rise and fall in pregnancy?

Fetal monitoring:
- What is used to monitor them?

Answer 5

Rise then fall, then rise again

Fetal echocardiography - 20 wks
Fetal growth and amniotic fluid volume - 28, 32, 36 wks

Question 6

Management:

Delivery:

• At what wk should delivery be offered?
• Type? - 2
• What is used to maintain glucose between 4-7 during labour?
• How often should glucose be monitored during labour?

Post-partum:

• Within what time should you check babies glucose?
• Under what level is urgent?
• What about what was being used to maintain the glucose?

Answer 6

37 wks

Induced labour or c-section

Variable-rate insulin infusion

Within 30 minutes

<2mmol/L

The infusion should be halved, then reduced to the normal regime