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MRCOG Maternal Medicine > Diabetes in pregnancy NICE > Flashcards

Diabetes in pregnancy NICE Flashcards

1
Q

Risk of T1/T2DM on pregnancy?

A

Increased risk miscarriage, congenital malformation, stillbirth neonatal death

Reduced but not eliminated with good glycaemia control

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2
Q

Pre-pregnancy advice T1/T2DM

A

Lose weight if BMI >27
5mg folic acid until 12/40
Monthly HbA1ca aiming <48 6.5%
T1DM fasting BM 5-7 on waking and before meals 4-7
Stop other agents other than insulin and metformin
Stop ACEi/ARBs/statins
Retinal assessment
Renal assessment - measure alumbinuria

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3
Q

If HbA1C above which level should you advice against pregnancy until lowered?

A

> 86 10%

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4
Q

Which long acting insulin is 1st line in pregnancy?

A

Isophane insulin (NPH insulin) or can continue long acting analogues (detemir/glargine)

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5
Q

When to refer to nephrologist before stopping contraception

A

Serum creatinine >120 or
urinary albumin creatinine ration >30
eGFR < 45

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6
Q

Which women are at risk of GDM

A

BMI >30
Previous >4.5kg baby
Prv GDM
1st degree relative with GDM
Ethnicity with high prevelcne
Glycosuria 2+ 1 occasion, or 1+ on 2 occasions

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7
Q

If previous GDM when to offer testing

A

Either early self monitoring
or
75g 2 hr OGTT as soon as after booking and at 24/28 weeks gestation

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8
Q

If other risk factor when to perform OGTT

A

24-28 weeks

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9
Q

Dx women with OGTT if

A

Fast >5.6
2hr >7.8

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10
Q

After GDM Dx, how quickly should be seen in JANC?

A

1 week

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11
Q

What risks should be explained to GDM

A

Fetal macrosomia
Trauma during birth (her and baby)
IOL and CS
Neonatal hypoglycaemia
Perinatal death

Reduced with BM control

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12
Q

For which women can a trial of diet and exercise be offered

A

If fasting BM <7

If targets not met within 1-2 weeks offer metformin

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13
Q

If fasting BM >7 in GDM Dx

A

Offer immediate treatment with insulin +/- metformin

Diet and exercise changes

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14
Q

If BMI 6-6.9 and complications such as macrosomia/hydramnios

A

Immediate Insulin +/- metformin
Diet and exercise

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15
Q

If Type 1 or Type 2/GDM on multiple day insulin, when to test Bus

A

Fasting
Pre-meal
1 hours post meal
Bedtime blood glucose

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16
Q

T2DM or GDM managing with diet or single therapy or intermediate/long acting insulin

A

Fasting
1 hour post meal

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17
Q

What are the BM targets for fasting, 1 hour after meal, 2 hour after meal

A

fasting 5.3
1 hour 7.8
2 hour 6.4

If on insulin aim >40

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18
Q

When to measure HbA1c for pre-existing

A

At booking, consider in 2nd/3rd trimester

> 48 associated with risk to pregnancy

19
Q

Why need to rate insulin infections sites

A

Avoid cutaneous amyloidosis

20
Q

How to minimise risk of hypoglycaemia

A

Educated women on insulin treated DM from 1st trimester

Always have fasting acting form of glucose available

Provide glucagon to T1DM, explain to partner/family for to use

Consider continuo subcut insulin - if multiple daily injections of insulin, multip hypos

21
Q

Who should be offered real time continuous glucose monitoring?

A

T1DM or T2DM/GDM if problematic hypos, unstable BMa

Offered intermittently scanned continue BM monitoring if unable to use rtCGM or patient preference

22
Q

How to minimise risk of DKA

A

Type 1 DM - offer blood ketone testing strips

T2DM/GDM: advise if unwell or high BM seek medical attention

Test blood ketones early if DM and high BMs/unwell

If suspected DKA - level 2 critical unit

23
Q

When to offer retinal assessment?

A

Pre-exisiting DM
1st appointment
If they have DM retinopathy - again 16-20 weeks
Another test 28 weeks

24
Q

When to offer renal assessment, when to refer to nephrologist?

A

At 1st appointment if not done in last 3 months

refer if
Creatinine >120
urinary albumin: creatinine ration >30
Total protein excretion >0.5g/day

25
Q

When to consider thromboprophylaxsis in pregnant women?

A

Proteinuria >5g/day

26
Q

Which women require aspirin?

A

T1DM or T2DM

27
Q

USS in pregnancy

A

7-9 week viability USS
Detailed 20 week including cardiac
Every 4 weeks from 28-36 weeks

28
Q

How often should be seen in JANC

A

Every 1-2 weeks

29
Q

What do discuss at 36 weeks

A

USS
Timing/mode delivery
Analgesia/anaesthesia
Changes to blood glucose lower therapy PP
Care of baby after birth
Breastfeeding, effect of breastfeeding on blood glucose control
Contraction and FU

30
Q

If AN steroid needed for insulin treated DM

A

Offer additional insulin

31
Q

When should T1/T2 DM with no other complications be delivery

A

Offer IOL (or CS if indicated) 37-38+6 weeks

32
Q

T1DM/T2DM who have metabolic, maternal/fetal complications?

A

Consider birth before 37 weeks

33
Q

Timing of delivery GDM

A

Delivery by no later than 40+6

34
Q

Which DM women should be seen by anaesthetics in 3rd trimester?

A

High BMI
Autonomic neuropathy

35
Q

IF GA for brith how often should BM be monitored

A

Every 30 mins from GA until baby born and woman conscious

36
Q

How often should BM be monitored in labour, what is the target?

A

Hourly
4-7

37
Q

When to consider IV dex + insulin infusion

A

Type 1 or
Not maintaining BM 4-7 in labour

38
Q

When to test baby Bus

A

Between 2 and 4 hours

39
Q

When to consider fetal ECHO

A

Clinical signs CHD/cardiomyopathy including heart murmur

40
Q

Whan can babies of diabetic mothers be transferred to community?

A

24hrs hold and satisfied maintain BM and feeding well

41
Q

How often should women with DM feed their babies?

A

As soon as possible after birth (within 30mins) and then every 203 hours to maintain pre-feed CBG >2

Only offer additional measures if <2 on 2 reading, abnormal clinical signs, baby not feeding effectively

42
Q

Post delivery what change to DM medication

A

Pre-exisiting DM - reduce insulin immediately, be aware of risk of hypoglycaemia

GDM - stop blood glucose lowering therapy

43
Q

PN advice

A

Contraceptive care
GDM - test glucose before discharge, early testing next pregnancy, lifestyle advice, 6-13 week fasting glucose, >13 weeks HbA1C.

44
Q

If 6-13 weeks fasting BM
<6, HbA1c <39
6-6.9/ 39-47
>7/>47

A

<6/<39 low probability of DM at the moment, continue lifestyle, annual blood glucose level/HbA1x

6-6.9/39-47 high risk developing T2DM, advice, guidance

> 7/>48 - have T2DM

MRCOG Maternal Medicine (41 decks)

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