Diabetes in pregnancy - from preconception to the postnatal period. NG3. December 2020 Flashcards
What blood glucose range should women with T1DM be advised to aim for pre-pregnancy?
Fasting - 5-7 on waking
Pre-meal 4-7 at other times of the day
Which HbA1c level should women be told to aim for pre pregnancy?
Below 48 or 6.5%
Above which HbA1c level should women be advised not to get pregnant?
86 or 10%
Which long acting insulin should be the first choice in pregnancy?
Isophane insulin aka NPH insulin
Consider continuing long acting insulin analogues - insulin detemir or insulin glargine - for women with established good control. Note this is off label
When should you consider referring women to a nephrologist before stopping contraception?
Creatinine is 120 or more
Urinary albumin creatinine ratio is >30 or
eGFR is less than 45
What are the risk factors for GDM that should prompt offering OGTT.
BMI >30
Previous macrosomic baby weight 4.5kg or more
Previous GDM
FHx of diabetes
Ethnicity with high prevalence diabetes
also glycosuria 2+ on 1 occasion, or 1+ on 2 or more occasions
diagnose GDM if:
Fasting 5.6 or above
2 hour 7.8 or above
If GDM is diagnosed
offer review in joint diabetes ANC within 1 week.
When does the DVLA need to be informed
If insulin treatment last (or will last) more than 3 months
If insulin treatment for GDM continues for over 3 months after birth
If they get disabling hypoglycaemia
Bus coach or lorry drivers
Below which level of fasting glucose can women be offered at trial of diet and exercise?
below 7mmol/litre at diagnosis.
Offer metformin if targets are not being met with diet and exercise changes within how many weeks?
1-2 weeks
If women have a fasting blood glucose level above 7mmol at diagnosis offer:
Immediate treatment with insulin with or without metformin and
Diet and exercise
If fasting glucose is 6-6.9 but there is macrosomia or polyhydramnios consider
Immediate treatment with insulin with or without metformin and
Diet and exercise
What are the target levels
Fasting - 5.3
1hr post meal 7.8 or
2hr post meal 6.4
Maintain above 4
If a woman has pre existing diabetes when should retinal assessments be offered?
After the first ANC visit unless they have had an assessment in the last 3 months
If they have retinopathy offer additional assessments
between 16-20 weeks
at 28 weeks.
refer a pregnant woman with pre existing diabetes to a nephrologist if:
Cr 120 or more
albumin creatinine ration greater than 30
Total protein excretion exceeds 0.5g a day
What is the nephrotic range of proteinuria?
Proteinuria above 5g a day or
albumin creatinine ratio greater than 220mg/mmol
What is the recommended US schedule for diabetes in pregnancy
fetal growth and LV every 4 weeks from 28-36 weeks.
TOB for women with T1 or T2 diabetes with no other complications
advise IOL or ELCS (if indication) between 37 and 38+6
TOB for women with T1 or T2 diabetes with metabolic or fetal complications.
Consider birth before 37 weeks
TOB with GDM
Advise women to give birth NO LATER than 40+6
What are the maintenance levels during labour and birth
between 4 and 7
What postnatal tests are recommended?
Fasting blood glocose test between 6 and 13 weeks or
fasting blood glucose at 13 weeks or HbA1c
What are the fasting blood glucose levels results and interpretation postnatally
<6 not diabetes
6-6.9 high risk of developing diabetes
=>7 - T2DM
confirmatory test required
What are the postnatal HbA1c level significance/ interpretations.
<39 - not diabetes
39-47 - high risk
=>48 they have T2DM
