Diabetes in Pregnancy

Question 1

when do levels of luteinising hormone peak in the cycle of ovulation

Answer 1

around day 14, just before ovulation

Question 2

what is the follicle called after ovulation

Answer 2

corpus luteum

Question 3

what is produced by the corpus luteum

Answer 3

progesterone (and oestradiol)

Question 4

what is produced by the follicle

Answer 4

oestradiol

Question 5

what hormone is produced if implantation of the corpus luteum occurs

Answer 5

HCG(this is what is tested for in pregnancy test)

Question 6

what are the 3 main hormones produced by the placenta in pregnancy

Answer 6

human placental lactogen(hPL), placental progesterone, placental oestrogens

Question 7

what is produced by the pituitary in pregnancy

Answer 7

prolactin(lactogen), needed to produce milk

Question 8

what hormones play a role in increased insulin resistance in pregnancy

Answer 8

hPL and placental progesterones

Question 9

what can happen if a pregnant women is already predisposed to insulin resistance before being pregnant

Answer 9

raised blood glucose and gestational diabetes

Question 10

what are the 3 types of diabetes see in pregnancy

Answer 10

T1DM, T2DM and gestational diabetes

Question 11

when does foetal organogenesis occur in pregnanacy

Answer 11

starts at ~5 weeks, possibly earlier

Question 12

what complications can arise in pregnancy as a result of T1 or T2DM

Answer 12

congenital malformation, prematurity, intra-uterine growth retardation(IUGR)

Question 13

what complications of pregnancy are specific to congenital diabetes

Answer 13

macrosomia(large baby weight/size), polyhydramnios, intrauterine death

Question 14

what complications can arise in the neonate from diabetes

Answer 14

resp. distress(immature lungs), hypoglycaemia(fits), hypocalcaemia(fits), CNS defects, skeletal abnormaltities, ureteric duplication

Question 15

when does the foetus begin producing its own insulin and what effect does this have

Answer 15

in 3rd trimester, insulin is a MAJOR growth factor

Question 16

describe how diabetes in pregnancy can affect foetal growth

Answer 16

maternal hyperglycaemia results in foetal hyperglycaemia, and then foetal hyperinsulinaemia which then result sin macrosomia
(as well as neonatal hypoglycaemia)

Question 17

what pharmacological management should be used for pregnant T1DM and T2DM patients

Answer 17

folic acid 5mg, avoid ACEi and statins, for BP eg use Labetalol, start aspirin 12mg at 12 weeks

Question 18

what non-pharmacological management should be used for pregnant T1DM and T2DM patients

Answer 18

pre-pregnancy counselling(ie good sugar control pre-conception!), regular eye checks

Question 19

what non-pharmacological treatment should be used for T1DM, T2DM and gestational diabetes

Answer 19

diabetic diet, good blood glucose control, continuous glucose monitoring, monitor HbA1c, BP

Question 20

what drug treatment is used for T1DM during pregnancy

Answer 20

insulin

Question 21

what drug treatment is used for T2DM during pregnancy

Answer 21

metformin, will probs need insulin later on

Question 22

what drug treatment is used during gestational diabetes

Answer 22

metformin, may need insulin

Question 23

what follow up of gestational diabetes should be done

Answer 23

6 week post natal fasting glucose, ensures resolution of gestational or diagnosis of T2DM

Question 24

what lifestyle measures are used to prevent development of diabetes after gestational diabetes

Answer 24

keep weight low as possible, healthy diet, aerobic exercise, annual fasting glucose measures

Question 25

what % of people with gestational diabetes go on to develop T1 or T2DM

Answer 25

T1DM = <5%
T2DM = around 50% in 10-15 years after pregnancy