Diabetes n Pregnancy

Question 1

What is gestational diabetes?

Answer 1

Diabetes which arises during pregnancy and resolving after (within 6 weeks of birth)

Question 2

What is pre-gestational diabetes?

Answer 2

Type 1,2 and 4

Question 3

Effect of pregnancy on diabetes?

Answer 3

Increases insulin requirements
N&V can precipitate DKA
Ketosis is more common
Risk of diabetic retinopathy and diabetic neuropathy worsening

Question 4

Effects of pre-existing diabetes on pregnancy?

Answer 4

Congenital abnormalities 
Miscarriage 
IUD 
Worsening diabetic coms 
Hypos 
Hyperglycaemia 
HHS 
DKA

Question 5

Effects common to pre-existing adn gestational diabetes

Answer 5

Pre-eclmapsia

• Polyhydroaminos
• Macrosomnia
• Shoulder dystocia
• Neonatal hypoglycaemia

Question 6

If HBA1c is above what, you should avoid pregnancy?

Answer 6

86 mmol/mol

Should aim for 48mmol/mol

Question 7

Antenatal management?

Answer 7

High dose folic acid (5mg)
Assess renal function, retinopathy?, HbA1c
Review meds
Continuous glucose monitoring considered
VTE assessment
LDA from 12 weeks to reduce HT risk

Question 8

If type 1 or 2 diabetes when should delivery happen?

Answer 8

by 38 weeks and 6 days

Question 9

If someone has GDM delivry should happen by?

Answer 9

40 weeks roughly

Question 10

What happens to womens insulin resistance levels in pregnancy and why?

Answer 10

Increased resistance

HPL and other hormones (cortisol)

Question 11

Gestational diabetes usually occurs when

Answer 11

3rd trimester as this is when placenta is growing a lot more so much more HPL secreted

Question 12

Managemet of GDM can often be?

Answer 12

Lifestyle but some woman can be given metformin

Question 13

What happens post partum in GDM?

Answer 13

Women need tested 6 weeks after birth with fasting glucose test to ensure diabetes resolves
If not = T2DM