Diabetes in Pregnancy Flashcards
when do levels of luteinising hormone peak in the cycle of ovulation
around day 14, just before ovulation
what is the follicle called after ovulation
corpus luteum
what is produced by the corpus luteum
progesterone (and oestradiol)
what is produced by the follicle
oestradiol
what hormone is produced if implantation of the corpus luteum occurs
HCG(this is what is tested for in pregnancy test)
what are the 3 main hormones produced by the placenta in pregnancy
human placental lactogen(hPL), placental progesterone, placental oestrogens
what is produced by the pituitary in pregnancy
prolactin(lactogen), needed to produce milk
what hormones play a role in increased insulin resistance in pregnancy
hPL and placental progesterones
what can happen if a pregnant women is already predisposed to insulin resistance before being pregnant
raised blood glucose and gestational diabetes
what are the 3 types of diabetes see in pregnancy
T1DM, T2DM and gestational diabetes
when does foetal organogenesis occur in pregnanacy
starts at ~5 weeks, possibly earlier
what complications can arise in pregnancy as a result of T1 or T2DM
congenital malformation, prematurity, intra-uterine growth retardation(IUGR)
what complications of pregnancy are specific to congenital diabetes
macrosomia(large baby weight/size), polyhydramnios, intrauterine death
what complications can arise in the neonate from diabetes
resp. distress(immature lungs), hypoglycaemia(fits), hypocalcaemia(fits), CNS defects, skeletal abnormaltities, ureteric duplication
when does the foetus begin producing its own insulin and what effect does this have
in 3rd trimester, insulin is a MAJOR growth factor
describe how diabetes in pregnancy can affect foetal growth
maternal hyperglycaemia results in foetal hyperglycaemia, and then foetal hyperinsulinaemia which then result sin macrosomia
(as well as neonatal hypoglycaemia)
what pharmacological management should be used for pregnant T1DM and T2DM patients
folic acid 5mg, avoid ACEi and statins, for BP eg use Labetalol, start aspirin 12mg at 12 weeks
what non-pharmacological management should be used for pregnant T1DM and T2DM patients
pre-pregnancy counselling(ie good sugar control pre-conception!), regular eye checks
what non-pharmacological treatment should be used for T1DM, T2DM and gestational diabetes
diabetic diet, good blood glucose control, continuous glucose monitoring, monitor HbA1c, BP
what drug treatment is used for T1DM during pregnancy
insulin
what drug treatment is used for T2DM during pregnancy
metformin, will probs need insulin later on
what drug treatment is used during gestational diabetes
metformin, may need insulin
what follow up of gestational diabetes should be done
6 week post natal fasting glucose, ensures resolution of gestational or diagnosis of T2DM
what lifestyle measures are used to prevent development of diabetes after gestational diabetes
keep weight low as possible, healthy diet, aerobic exercise, annual fasting glucose measures
what % of people with gestational diabetes go on to develop T1 or T2DM
T1DM = <5% T2DM = around 50% in 10-15 years after pregnancy
