Diabetes- pre-existing during pregnancy, gestational and BF

Question 1

Complications of diabetes and pregnancy

Answer 1

pre-eclampsia, miscarriage, birth defects (neural tube defects) and still birth

Question 2

HbA1C and pregnancy- target

Answer 2

due to the complications women planning to become pregnant require tight glycemic control.

HbA1C= <48mmol/mol, 6.5%

Question 3

What should a diabetic take if they are planning to become pregnant?

Answer 3

Folic acid 5mg tablets, continued until 12 weeks pregnant

Question 4

What anti-diabetic medications should be stopped if pregnant?

Answer 4

all ORAL anti-diabetics (EXCEPT metformin)

drugs for diabetic complications- ACE/ARB and statins (teratogenic)

Question 5

How do you treat Diabetes mellitus during pregnancy?

Answer 5

insulin- normally:
rapid acting (insulin aspart and lispro)
+ intermediate acting isophane (first line- basal insulin)

if good glyceamic control prior to pregnancy with long acting (detemir or glargine) then these can be continued

Question 6

Insulin requirements during pregnancy

Answer 6

Highest during the 2nd and 3rd trimester- higher doses are required.

REDUCED AFTER BIRTH- RISK OF HYPOGLYCAEMIA

Question 7

What is gestational diabetes

Answer 7

High blood sugar levels which develop during pregnancy and normally disappear after birth.
- The body can’t produce enough insulin to meet the increased requirements.

Question 8

Treatment of gestational diabetes

Answer 8

if Fasting blood glucose:
<7mmol/L
- 1st line= diet and excersise
- 2nd line= Metformin (if BM targets aren’t
met after 1-2 weeks)
alternative= insulin

> 7mmol/L
- Insulin to be administered asap +/-
metformin

Question 9

What anti-diabetic drugs are safe to use while breastfeeding?

Answer 9

Insulin and Metformin
(all other oral anti-diabetics should be avoided)