Diabetes in pregnancy

Question 1

What are the differences between DM normally and during pregnancy?

Answer 1

Insu;in requirement increases- due to insulin resistance caused by hormones
Foetal hyperinsulinaemia –> macrosomia

Question 2

What is the management of DM pre conception?

Answer 2

Full assessment and optimise glycaemic control

5mg folic acid

Question 3

What is the management of DM during pregnancy?

Answer 3

Monitoring
Increase insulin dose
Induce labour at ~38 weeks, consider C section

Question 4

What is the management of DM in labour?

Answer 4

IV insulin dextrose
Continuous CTG
Early feeding of baby

Question 5

What is gestational diabetes?

Answer 5

Abnormal glucose intolerance that reverts to normal after pregnancy
Common

Question 6

What are the risk factors for gestational diabetes?

Answer 6

BMI >30
Previous baby >4.5kg
PMH/FH gestational diabetes
Polyhydramnios, big baby

Question 7

What is the screening for gestational diabetes?

Answer 7

Screen those with risk factors
HbA1c at booking
OGTT at 16 and 28 weeks

Question 8

What is the management of gestational diabetes?

Answer 8

1. Diet and exercise
2. Metformin
3. Insulin
   - Start on insulin straight away if fasting glucose >7

Question 9

What is the management of gestational diabetes post natally?

Answer 9

OGTT at 6-8 weeks

Annual HbA1c and BM

Question 10

What are the complications of diabetes in pregnancy?

Answer 10

Macrosomia 
Polyhydramnios 
Foetal congenital abnormalities 
Shoulder dystocia 
Infection 
Impaired lung maturity 
Neonatal hypoglycaemia and jaundice