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A. MLA Map Obstetrics and Gynaecology > Diabetes in pregnancy (gestational and pre-existing) > Flashcards

Diabetes in pregnancy (gestational and pre-existing) Flashcards

1
Q

Insulin allows cells to absorb the glucose in the blood. What type of receptors does insulin bind with?

1 - GPCR
2 - proton channel receptors
3 - receptors tyrosine kinase
4 - all of the above

A

3 - receptors tyrosine kinase

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2
Q

Once insulin has bound to receptor tyrosine kinase glucose can be absorbed. What transporters carry glucose into the cells?

A
  • glucose transports that migrate to the cell surface because of insulin
  • 1-4 are on different cells and have different sensitivity
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3
Q

Once inside the cell, what does insulin trigger the cell to do with glucose?

A
  • initiate glycogen synthesis (storing glucose as glycogen) called glycogenesis
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4
Q

Over 700,000 women in England and Wales give birth each year. What % of these have complications related to diabetes?

1 - 0.5%
2 - 5%
3 - 45%
4 - >60%

A

2 - 5%

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5
Q

Over 700,000 women in England and Wales give birth each year, 5% of which have complications related to diabetes. There are 3 types of diabetes that presents in pregnancy, which is most common?

1 - gestational diabetes
2 - T1DM
3 - T2DM

A

1 - gestational diabetes = 87.5%

  • T1DM = 7.5%
  • T2DM = 5%
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6
Q

Over 700,000 women in England and Wales give birth each year, 5% of which have complications related to diabetes. Gestational diabetes is the most common form, of which the prevalence is increasing. Which 2 of the following are the most common risk factors contributing to the increased prevalence?

1 - pregnancy in later life
2 - obesity
3 - age
4 - multiparty

A

1 - pregnancy in later life
2 - obesity

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7
Q

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. Does glucose production in the liver during pregnancy increase or decrease?

A
  • increases
  • hepatic glucose production increases by 16-30%
  • gluconeogenesis increases throughout pregnancy
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8
Q

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. Does insulin sensitivity increase or decrease during pregnancy?

A
  • insulin resistance increases
  • aprox 50-70% less effective by 3rd trimester
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9
Q

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. When does gluconeogenesis and insulin resistance peak during pregnancy?

1 - post-natally
2 - 3rd trimester
3 - 2nd trimester
4 - 1st trimester

A

2 - 3rd trimester
- weeks 29-40

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10
Q

Why is increased insulin resistance and gluconeogenesis important in pregnancy, especially during the 3rd trimester (weeks 29-40)?

1 - ensure sufficient glucose reaches foetus
2 - ensures maternal glucose is sufficient
3 - triggers T2DM as the insulin resistance is prolonged

A

1 - ensure sufficient glucose reaches foetus
- insulin resistance and gluconeogenesis ensure hyperglycaemia

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11
Q

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. As insulin resistance increases, hepatic glucose production is able to respond to the excess insulin production. In normal pregnancy what % of hepatic glucose production is suppressed by increased insulin concentration in the blood?

1 - 60%
2 - 80%
3 - 96%
4 - 100%

A

3 - 96%
- suppression of excess glucose to avoid gestational diabetes

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12
Q

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. As insulin resistance increases, hepatic glucose production is able to respond to the excess insulin production. In gestational diabetes what % of hepatic glucose production is suppressed by increased insulin concentration in the blood?

1 - 60%
2 - 80%
3 - 96%
4 - 100%

A

2 - 80%
- lower suppression leads to patient remaining in a higher hyperglycaemic state

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13
Q

In pregnancy the mothers glucose and insulin homeostasis changes and glucose is re-directed towards the foetus. The foetus is able to secrete a hormone that opposes insulin, leading to increased maternal insulin resistance. This in turn means more glucose is in the blood and gets to the foetus. What is this hormone called?

1 - placental growth like factor
2 - human placental lactogen
3 - oestrogen
4 - progesterone

A

2 - human placental lactogen

  • glucagon and cortisol are also released by the placenta in an attempt to raise glucose and lipid levels in the blood
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14
Q

In addition to maternal insulin resistance, lipid metabolism changes during pregnancy. Do triglycerides (TAG) and very low density lipoproteins (VLDL) typically increase of decrease in early pregnancy?

A
  • both are reduced
  • up to week 8 and then they begin to increase
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15
Q

Triglycerides (TAG) and very low density lipoproteins (VLDL) initially drop <8 wks of pregnancy, and then rising >8 wks. Which 2 of the following hormones are linked with the riae in TAGs and VLDLs?

1 - placental growth like factor
2 - human placental lactogen
3 - oestrogen
4 - insulin

A

3 - oestrogen
4 - insulin

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16
Q

To help maternal TAG and VLDL levels rise >8 weeks of pregnancy, which ezume in the blood is reduced?

1 - gastric lipase
2 - pancrreartic lipase
3 - lipoprotein lipase
4 - trypsin

A

3 - lipoprotein lipase
- extracts lipids from lipoproteins in blood

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17
Q

Do HDL levels increase or decrease by week 12 during pregnancy?

A
  • increase
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18
Q

Do total and LDL-cholesterol during the 2nd and 3rd trimester of pregnancy?

A
  • all initially decrease in pregnancy
  • then gradually increase in 2nd and 3rd trimester
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19
Q

DOes lipolysis (TAG breakdown into energy) increase or decrease during pregnancy>

A
  • increases
  • ensure continues energy to foetus through fatty acids and gluconeogenesis
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20
Q

In pregnancy there is increased hyperglycaemia and insulin resistance. What does the pancreas do in an attempt to mitigate this?

1 - increase the release of glucagon
2 - decrease the release of glucagon
3 - increase the release of insulin
4 - decrease the release of insulin

A

3 - increase the release of insulin
- attempts to restore euglycemia (normal blood glucose)

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21
Q

In pregnancy there is increased hyperglycaemia and insulin resistance. The pancreas, in an attempt to mitigate this increases insulin release, however some women are unresponsive to this, which causes what?

1 - T1DM
2 - T2DM
3 - gestational diabetes
4 - all of the above

A

3 - gestational diabetes

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22
Q

There are maternal risks of if a woman develops diabetes during pregnancy. Which of the following is NOT a common risk?

1 - pre-eclampsia (high BP and proteinuria)
2 - preterm labour
3 - worsening of diabetic retinopathy
4 - CKD

A

4 - CKD

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23
Q

Patients who have 1 high risk or 2 moderate risk factors as per the NICE guidelines for eclampsia they should be started on aspirin at what does?

1 - 50-100mg
2 - 100-200mg
3 - 75-150mg
4 - 200-260mg

A

3 - 75-150mg

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24
Q

In babies who’s mother has gestational diabetes the cord-blood serum C-peptide levels are above the 90th %. What does this indicate?

1 - elevated insulin was delivered to the baby
2 - reduced insulin was delivered to the baby
3 - maternal insulin was high
4 - maternal insulin was low

A

2 - reduced insulin was delivered to the baby
- C-peptide is a marker if insulin

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25
Q

There are neonatal risks of if a woman develops diabetes during pregnancy. Which of the following are common risks?

1 - congenital malformations
2 - macrosomia
3 - birth injury (shoulder dystocia)
4 - perinatal mortality, still birth and miscarriage
5 - postnatal hypoglycaemia (can impact babies cognitive development)
6 - all of the above

A

6 - all of the above
- patients can request an earlier scan due to risks

26
Q

Polyhydramnios is excessive amniotic fluid in amniotic sac. This can be dangerous and lead to the following, EXCEPT?

1 - premature delivery (< 37 weeks)
2 - waters breaking early
3 - microsomia
4 - prolapsed umbilical cord

A

3 - microsomia
- small babies

27
Q

Foetus born to a mother with diabetes are at increased risk of shoulder dystocia, which is when the baby’s head has been born but one of the shoulders becomes stuck behind the mother’s pubic bone. Why is this dangerous?

1 - vaginal tear
2 - brachial plexus injury (Erb’s palsy)
3 - death
4 - all of the above

A

4 - all of the above

28
Q

When a woman is planning on having a baby, what should be the target plasma glucose levels for:

  • a fasting plasma glucose (FPG)
  • plasma glucose (PG) throughout the day

to help reduce the risks associated with diabetes in pregnancy?

1 - FPG = 5-7 and PG = 4-7mmol/l
2 - FPG = 2-5 and PG = 5-8mmol/l
3 - FPG = >5.6 and PG = >5.7mmol/l
4 - FPG = >5.6 and PG = >7.8mmol/l

A

1 - FPG = 5-7 and PG = 4-7mmol/l

29
Q

What is the diagnosis of gestational diabetes in:

  • a fasting plasma glucose (FPG) or
  • 2 hour oral glucose tolerance test (OGTT) level

1 - FPG = 5-7 and OGTT = 4-7mmol/l
2 - FPG = 2-5 and OGTT = 5-8mmol/l
3 - FPG = >5.6 and OGTT = >5.7mmol/l
4 - FPG = >5.6 and OGTT = >7.8mmol/l

A

4 - FPG = >5.6 and OGTT = >7.8mmol/l

30
Q

When a woman is planning to become pregnant, a BMI greater than what would trigger advice on losing weight given to the mother?

1 - >20
2 - >25
3 - >27
4 - >35

A

3 - BMI >27 kg/m2

31
Q

When a woman is planning to become pregnant, folic acid (B9) should be provided until 12 weeks of gestation. In non-diabetes patients, they advice is 400mcg, but what level should this be in pre-existing diabetes?

1 - same 400mcg
2 - 1mg
3 - 5mg
4 - 10mg

A

3 - 5mg
- crucial for DNA and RNA and reduces risks of neural tube defects

32
Q

During the pre-conception phase females at risk of developing or have pre-exisiting diabetes should have all the following EXCEPT which one?

1 - retinal screening through digital imaging
2 - nephropathy screening
3 - OGTT
4 - liver scan

A

4 - liver scan

33
Q

Nephropathy needs to be screened for in patient with pre-existing and those at risk of developing diabetes. Which measures of the kidneys is NOT essential?

1 - creatinine of >120micromol/L
2 - urinary albumin:creatinine ratio >30mg/mol
3 - U&Es
4 - eGFR <45ml/minute/1.73m2

A

3 - U&Es
- should be done, but not as important as the others

34
Q

In a woman who is considering becoming pregnant and has or is at risk of diabetes, what blood test should be done monthly?

1 - OGTT
2 - HbA1c
3 - Fasting glucose
4 - Renal function

A

2 - HbA1c test

35
Q

In a woman who is considering becoming pregnant and has T1DM, do they need to alter their insulin levels?

A
  • yes they may need to increase insulin levels
  • self monitor glucose and ketones is important
36
Q

What is the HbA1c target for women who are considering becoming pregnant?

1 - <40mmol/L
2 - <48mmol/L
3 - <58mmol/L
4 - <68mmol/L

A

2 - <48mmol/L

37
Q

If a woman has a HbA1c >86mmol/L (10%) and is considering becoming pregnant, what advise should they be given?

1 - insulin will be needed throughout pregnancy
2 - do not become pregnant until HbA1c is lower

A

2 - do not become pregnant until HbA1c is lower

38
Q

What are the 2 diabetic medications are permitted in pregnancy?

1 - Insulin
2 - Dulaglutide
3 - Metformin
4 - Dapagliflozin

A

1 - Insulin
3 - Metformin
- inhibits gluconeogensis

39
Q

Some women may be on cholesterol and blood pressure medications prior to pregnancy. What of the following medications is ok to take during conception and in labour?

1 - metformin
2 - statins
3 - angiotensin-converting enzyme inhibitors
4 - angiotensin-II receptor antagonists

A

1 - metformin

40
Q

Which of the following are risk factors for developing gestational diabetes?

1 - BMI >30kg/m2
2 - previous macrosomic baby >4.5kg
3 - previous gestational diabetes
4 - first degree relative with diabetes
5 - ethnic minority with high incidence of diabetes
6 - all of the above

A

6 - all of the above

41
Q

If a women has any of the risk factors for gestational diabetes below are present in a pregnant women:

1 - BMI >30kg/m2
2 - previous macrosomic baby >4.5kg
3 - previous gestational diabetes
4 - first degree relative with diabetes
5 - ethnic minority with high incidence of diabetes

What test should be performed between weeks 24-28?

1 - fasting blood glucose
2 - HbA1c
3 - plasma glucose
4 - OGTT

A

4 - OGTT
- gold standard for diagnosing gestational diabetes
- diagnosis =
fasting glucose >7mmol/L OR
2h OGTT >11.1mmol/L

42
Q

In a patient with gestational diabetes, what is the first line treatment?

1 - insulin
2 - metformin
3 - lifestyle change (diet and exercise)
4 - dapagliflozin

A

3 - lifestyle change (diet and exercise)
- if still glucose or HbA1c is still high then metformin, and finally insulin

43
Q

In a patient with T2DM, are they able to stay on their current diabetes medication?

A
  • yes if stable and on metformin
  • if no then need to go on insulin
44
Q

Insulin may be prescribed to a patient with gestational diabetes. What is the main risk of this?

1 - retinopathy
2 - hypoglycaemia
3 - hyperglycaemia
4 - neuropathy

A

2 - hypoglycaemia

-

45
Q

In a female patient with gestational diabetes, what should be tested if the patient already has T1DM?

1 - glucose
2 - renal function
3 - ketones
4 - LFTs

A

3 - ketones
- if patient presents with hyperglycaemia or is unwell they should be tested for ketonaemia immediately

46
Q

What 2 diabetic medications can help reduce glucose absorption in the GIT?

1 - Dapagliflozin
2 - Dulaglutide
3 - Acarbose
4 - Metformin

A

3 - acarbose
4 - metformin

47
Q

What diabetic medications can help increase lipogenesis in adipose tissue and the liver (excess energy stored as TAG)?

1 - Dapagliflozin
2 - Dulaglutide
3 - Insulin
4 - Metformin

A

3 - insulin

48
Q

What diabetic medications can help increase glucose uptake in the muscles?

1 - Dapagliflozin
2 - Dulaglutide
3 - Insulin
4 - Metformin

A

4 - metformin

49
Q

What diabetic medications can help increase glycogenesis in the muscles and liver?

1 - Dapagliflozin
2 - Dulaglutide
3 - Insulin
4 - Metformin

A

3 - insulin

50
Q

What diabetes medication can reduce gluconeogenesis in the liver?

1 - Dapagliflozin
2 - Dulaglutide
3 - Insulin
4 - Metformin

A

4 - metformin

51
Q

What diabetic medications can help increase glucose excretion through the kidneys?

1 - Dapagliflozin
2 - Dulaglutide
3 - Insulin
4 - Metformin

A

1 - Dapagliflozin
- SGLT2 inhibitors

52
Q

During birth and labour hourly continuous capillary blood glucose monitoring should be performed. What is the levels the blood glucose should remain within?

1 - 3-8 mmol/L
2 - 4-7 mmol/L
3 - 4-11.1 mmol/L
4 - 3-11.1 mmol/L

A

2 - 4-7mmol/L
- if not within this range then a variable rate infusion of insulin should be administered

53
Q

During birth and labour what do patients with T1DM require insulin given how?

1 - bolous with long acting
2 - variable rate infusion
3 - rapid acting insulin
4 - long actin insulin alone

A

2 - variable rate infusion

54
Q

Following birth the baby should also be monitored, called neonatal care. What blood measures should be taken from the baby following delivery?

A
  • capillary blood glucose
  • polycythaemia (high RBC count)
  • hyperbilirubinaemia
  • hypocalcaemia
  • hypomagnesaemia
55
Q

Following birth, is the baby at risk of hypo or hyperglycaemia?

A
  • hypoglycaemia
  • foetal insulin will also contribute by being high
56
Q

if a baby has indications of cardiac malformations that may occur due to gestational diabetes, what test should be performed?

1 - ECG
2 - echocardiogram
3 - heart rate
4 - BP

A

2 - echocardiogram

57
Q

Following birth, women with existing diabetes, does this return to pre pregnancy levels or remain high?

A
  • return to pre-pregnancy care providing no issues
58
Q

Following birth, women with gestational diabetes, does this return to pre pregnancy levels or remain high?

A
  • typically returns to normal
  • GP should monitor
59
Q

If a woman had gestational diabetes, there is a risk of them developing diabetes. When should a fasting plasma glucose (FPG) and/or HbA1c be tested following birth to asses the patients risk pf developing diabetes?

1 - 1-2 weeks post-natally
2 - 2-6 weeks post-natally
3 - 6-13 weeks post-natally
4 - 10-20 weeks post-natally

A

3 - 6-13 weeks post-natally
- HbA1c = 13 weeks

60
Q

If a woman had gestational diabetes, there is a risk of them developing diabetes. Looking at the values below, match them with low and high risk of developing diabetes and a diagnosis of T2DM:

  • FPG = <6.0 mmol/L or HbA1c = <39 mmol/mol
  • FPG = >7.0 mmol/L or HbA1c = >48 mmol/mol
  • FPG = 6.0-6.9 mmol/or LHbA1c =39-47 mmol/mol
A
  • LOW RISK = FPG = <6.0 mmol/L or HbA1c = <39 mmol/mol
  • HIGH RISK = FPG = 6.0-6.9 mmol/or LHbA1c =39-47 mmol/mol
  • T2DM = FPG = >7.0 mmol/L or HbA1c = >48 mmol/mol

A. MLA Map Obstetrics and Gynaecology (29 decks)

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