DIABETES;PREGNANCY

Question 1

What are risks of diabetes in pregnancy?

Answer 1

Increased risk to the woman (pre-eclampsia) and to the developing foetus.

Effective blood glucose control before conception and throughout conception and reduces the risk of adverse outcomes e.g stillbirth, miscarriage and neonatal death

Question 2

What advice should be given to diabetic women trying to get pregnant?

Answer 2

Keep HbA1c levels below 6.5% which reduces the risk of congenital defects

Take folic acid 5mg

Should be aware of risks of hypoglycaemia esp in 1st trimester and advised to always carry dextrose tablets or glucose contains drink.

Type 1; prescribed glucagon for use if needed

Question 3

What anti diabetic medication is safest in pregnancy and breastfeeding?

Answer 3

Metformin

Question 4

GESTATIONAL DIABETES;

What treatment for fasting BG <7mmol?

Answer 4

Change diet and exercise to decrease BG
If BG target is not met in 1-2 weeks, then start metformin (or insulin if contraindicated)

Question 5

What is treatment if fasting BG is >7mmol/L?

Answer 5

Treat with insulin immediately with or without Metformin.

Isophane is first choice for long acting insulin

Discontinue hypoglycaemic treatment immediately after giving birth,

Question 6

What should be given if fasting glucose is 6-6.9mmol/L with complications such as macrosomia or hydramnios?

Answer 6

Immediate insulin treatment with or without metformin