Diabetes in pregnancy

Question 1

classification

Answer 1

• gestational
  
  • onset w pregnancy and resolves upon giving birth
• pre-existing diabetes

Question 2

pathophysiology?

Answer 2

reduced insulin sensitivity therefore mother’s insulin requirements go up

progesterone, bHCG & cortisol from placenta all have anti-insulin effects

Question 3

RF to develop gestational?

Answer 3

• BMI > 30
• FH of diabetes
• previous GD
• previous baby with macrosomia
• asian, black caribbean or middle eastern ethnicity

Question 4

Ix?

Answer 4

anyone w risk factors gets screened w/ OGTT at booking and at 26 weeks

Question 5

OGTT results that indicate gestational diabetes

Answer 5

baseline <5.6

after 2 hrs <7.8

if above this –> gestational diabetes

Question 6

Mx of pre-existing diabetes

Answer 6

• pre-conception
  
  • folic acid –> 12 weeks
  • better glycaemic control
• pregnancy
  
  • optimise glucose control w metformin or insulin
  • retinopathy screening
• labour
  
  • maintain blood sugar w insulin

Question 7

Mx of gestational diabetes

Answer 7

fasting glucose < 7: diet & exercise

fasting glucose > 7: insulin

Question 8

effects of diabetes on foetus?

Answer 8

• increase risk of congenital anomaly
• perinatal mortality
• macrosomia
  
  • caused by foetal hyperinsulinaemia
• polyhydramnios
• shoulder dystocia
• neonatal hypoglycaemia

Question 9

effects of diabetes on mother?

Answer 9

• higher risk of miscarriage, PET and infections
• retinopathy & nephropathy way worsen