Diabetes mellitus

Question 1

GDM

Answer 1

Arbitrary cut off placed on the normal spectrum of IGT in pregnancy.
Importance of diagnosis:
- 40-60% risk of diagnosis of T2DM later in life (with risks associated)
- Identifying pre-existing
- Higher risk of macrosomia and adverse pregnancy outcomes.

HAPO cut offs: 5.1, 10, 8.5 (fasting, 1hr and 2hr) - 1.5 fold significant risk associated with pre-eclampsia and SD and birth injury
ACHOSIS showed treatment reduced adverse outcomes

Diet, exercise, moderate weight gain,

Question 2

Pre-existing diabetes

Answer 2

Review macrovascular disease (CVS, IHD, peripheral vascular disease)
Microvascular disease (retinopathy, nephropathy, neuropathy)

Type 1 require higher insulin doses
Type 2 require higher doses
Deterioration in renal function worse in women with pre-existing disease and HTN. In women with mild disease this is reversed PP.
Two fold increase in diabetic retinopathy progression sometimes due to rapid improvement of glycaemic control.
Hypoglycaemia more common.
DKA rare but higher risk in early pregnancy.

Maternal pregnancy risks: Miscarriage, PET, infection, CS
Fetal: congenital abnormalities (NTD and CHD), sacral agenesis, perinatal mortality, SB, macrosomia, IUGR
Labour consideration: difficulty monitoring, SD, PPH, CS, VTE

Type 1 and2 (on long acting insulin) should be on a sliding scale in labour aiming 4-7mmol/L
Reminder to include K+
PP insulin requirements rapidly return to normal.