Diabetes in Pregnancy Flashcards
Which groups are affected by diabetes more?
Asian descent
What is true diabetes?
A fasting blood glucose of >5,6mmol/l
Or random blood glucose of 11mmol/l
Or post-prandial(After 2 hours of glucose load) glucose of >7,8mmol/l
With the 4 P’s
How much glucose is given in the the glucose tolerance test?
75 g
What is the antenatal effect of diabetes on the pregnancy?
- Polyhydroamnios
- Macrosomia
- Intra-uterine death
- Congenital cardiac lesions
What are the problems we encounter during delivery with patients with Diabetes mellitus?
Shoulder dystocia (Erb’s palsy)
What are the post-partum effects we can expect as a result of diabetes?
- Hyperbilirubinaemia
- Respiratory distress syndrome
- Neonatal hypoglycemia
- Polycythemia
How does a macrosomic baby look?
They have a large body and normal sized head
What is the pathophysiology of diabetes in the fetus?
The mother’s hyperglycaemia (due to insulin resistance) causes fetus hyperglycaemia
This then leads to the glucose being stored as glycogen and fat in the cells
What are the micro vascular effects of long-standing diabetes?
- Neuropathy
- Retinopathy
- Nephropathy
What is the appropriate blood glucose goal for these patients?
- A fasting blood glucose of less than 5,6mmol/l
- A post-prandial blood glucose of <7mmol/l
- HBA1C of less than 6,5% is ideal
What is the management of patients with type 1 DM?
Insulin therapy
What is the management of type 2 DM?
Diet change as well as oral metformin (500mg) twice daily or 850mg three times a day
How often do we need to see diabetic patients?
We need to see them every two weeks until they are 36 weeks and then every week thereafter
How much energy intake should a patient with DM get daily?
126-147 kilojoiules/kg
What are the insulin options available?
3 injections of actrapid are preferred before breakfast, lunch and supper and intermediate acting insulin(Protophane) is given just before bed to prevent hypoglycemia during the night
How do we determine the patients blood glucose profile?
The patient should have nothing to east from midnight until the next morning around 8 o clock
‘We then test the blood glucose and then they have something to eat and then test the blood glucose again after 2 hours
What should we do to manage these patients antenatally?
- Do fundoscopy to look for diabetic retinopathy
- 24 hour urine test and renal function tests(checking for nephropathy)
- Ultrasnound
- HBAC1
- Bacteriology to look for asymptomatic
Why do most obstetricians induce labour as soon as the patient is 38 weeks?
Because they are avoiding the unexplained chance of stillbirths happening
How can we determine the gestational age if we are unsure?
We can do an amniocentesis for pulmonary maturity
What method of delivery is best for these patients?
Either NVD or c/s if there are indications for it
In the case of ketonuria what is increased in the preparation of delivery?
Both insulin and glucose
Why should a doctor skilled in neonatal resuscitation be present at the birth of the baby?
Because of the possible respiratory distress and shoulder dystocia
What is insulin lispro?
A rapid acting human insulin analogue that comes in 3 and 10 ml vials given subcutaneously 15 minutes before a mealk
What is the definition of gestational diabetes?
Diabetes presenting during pregnancy and has a high propensity to progress to type 2 DM later in life
Describe type 1 diabetes?
Absolute Insulin deficiency due to pancreatic b-cell dysfunctio
Describe type 2 diabetes?
Increasing insulin resistance due to increased demand for insulin leading to complete dysfunction with B-cell failure
Which patients are at a increased risk of developing gestational diabetes?
- Previous gestational diabetes
- Above 40 years
- BMI>40 or >90 kg
- Family history
- Asian descendants
What types of diabetes do we have?
- Pre-gestational diabetes: type 1 or 2
- Gestational diabetes
- Undiagnosed diabetes mellitus
What do we often find on amniocentesis to assess lung maturity?
The presence of 2,5 L:S ratio or the presence of phosphatidyl-glycerol
What are the 1st trimester effects on the baby due to DM?
- Congenital abnormalities:
-Cardiac: VSD, Tetralogy of fallot
Pulmonary atresia
-neural tube defects
-renal and renal tract defects - Miscarriages can also happen
What is the 2nd trimester effects on the baby due to DM?
- Unexplained Intra-uterine foetal death
- Pre-eclampsia
- Intra-uterine growth restriction
What are the 3rd trimester effects on the baby due to DM?
- Polyhydroamnios
- Macrosomia
- Unexplained foetal death
- Preterm labour
- Cardiomyopathy-hypertrophy, hyperplasia
How often do we do the HBA1C test?
At booking and every 8 weeks
