Diabetes in Pregnancy

Question 1

What are the teratogenic effects associated with diabetes in pregnancy (3)?

Answer 1

(1) Congenital Cardiac Malformations
(2) Spinal Cord Defects
(3) Cleft Lip/Palate

Question 2

What are the labour-related complications of diabetes in pregnancy (4)?

Answer 2

Miscarriage
Shoulder Dystocia
Pre-term Labour
Stillbirth

Question 3

Which oral hypoglycaemic agents are reasonable to continue until pregnancy is confirmed when pre-conception planning?

Answer 3

Metformin

Glyburide

Question 4

When do you start ASA in pregnant patients with diabetes?

Answer 4

Start ASA 162 mg daily at 12-16 weeks until 36 weeks to decrease the risk of preeclampsia.

Question 5

What is the target HbA1c in pre-pregnancy?

Answer 5

HbA1 < 7%, but ideally < 6.5%

Question 6

What are the benefits of continuous glucose monitoring in pregnant patients with type I diabetes (3 maternal, 3 fetal)?

Answer 6

Maternal Outcomes

(1) Less hyperglycaemia
(2) More time in target glycemic range.
(3) Small reduction in HbA1c

Fetal Outcomes

(4) Reduced fetal large for gestational age
(5) Reduced fetal hypoglycaemia
(6) Reduced NICU admissions

Question 7

What is the fasting BG target in patients with diabetes in pregnancy?

Answer 7

Fasting Target < 5.3

Question 8

What is the target HbA1c during pregnancy?

Answer 8

< 6.5%

Question 9

What are the 1 hr and 2 hr post-prandial targets for pregnancy patients with diabetes?

Answer 9

1-Hr Post-Prandial: < 7.8

2-Hr Post-Prandial: < 6.7

Question 10

What are the intrapartum BG targets for pregnancy patients with diabetes?

Answer 10

4.0-7.0

Question 11

How often/when should pregnant patients with diabetes be monitoring their blood sugar?

Answer 11

Fasting & Two Hrs Post-Prandial

4 x Daily

Question 12

When do you screen for gestational diabetes in regular risk pregnant patients? High risk?

Answer 12

Between 24-28 weeks in patients at regular risk.

In high risk patients, screen earlier with HbA1c or FBG, but repeat between 24-28 weeks if negative at earlier screening.

Question 13

What are the diagnostic cutoffs for gestational diabetes with the 50g 1 hr OGCT?

Answer 13

Gestational Diabetes: > or = 11.1
Borderline: 7.8-11.1 (Move to OGTT)
Normal: < or = 7.8

Question 14

What are the cutoffs for the 75g 2 hr OGTT in pregnancy?

Answer 14

If used as second step (after borderline 50g):

FPG > or = 5.3, 1 hr > or = 10.6 or 2 hr > or = 9.0

Question 15

What insulin therapy is first line in diabetes?

Answer 15

NPH (to target fasting blood sugars)

Fast acting insulin to target postprandial blood sugars.

Question 16

What should you screen patients with T1DM for in the postpartum period?

Answer 16

Postpartum thyroiditis

Question 17

How do you manage gestational diabetes in the postpartum period?

Answer 17

(1) STOP insulin/metformin/glyburide postpartum.

(2) 75g OGTT at 6 weeks - 6 months postpartum to assess for T2DM

Question 18

In patients with GDM, what is the risk of gestational diabetes in future pregnancies and development of T2DM?

Answer 18

50% of women will have GDM in subsequent pregnancies.

20% of women will develop T2DM in 10 years.

Question 19

What have Diabetes Canada & the SOGC recommended as an alternative to screening for gestational diabetes in pregnancy during COVID?

Answer 19

A1C and random plasma glucose

A1C > or = 5.7 OR
Random plasma glucose > or = 11.1 mmol/L

Gestational Diabetes

Question 20

What is the target weight gain during pregnancy in patients with BMI > 30?

Answer 20

5-10 kg

Question 21

If a pregnant patient acquires COVID, what are they at higher risk for (3)?

Answer 21

ICU Admission
Mechanical Ventilation
Preterm Labour in the 3rd Trimester