Diabets and pregnacy

Question 1

What does diabetes in pregnancy incoperate

Answer 1

GDM, T1DM & T2DM

T2DM prevalence increasing

Question 2

prevalence of diabetes in pregnacy

Answer 2

5% pregnancies affected by diabetes

87.5% of these are GDM

Question 3

cuase of T1dm and who gtets it

Answer 3

organ specific auto-immune disease

young, slim, european

Question 4

cause of T2DM and who gets it

Answer 4

strong genetic component
-peripheral insuline ressitance

older and fatter
-ethniciity important

Question 5

glucose physiological changes in pregnancy 4

Answer 5

state of increasing insulin resistance

fasting glucose decreased and post prandial increased compare to non pregnant

normal women double insulin production from 1st to 3rd trimester

glycosuria and ketosis common in pregnancy

Question 6

what causes hyperglycaemia in pregnancy

Answer 6

placenta produces human placental lactogen
-this increases insulin resistance and human chorionic somatomammotrophin which increases production of insulin

Question 7

basic pathophys of gestational diabetes

Answer 7

maternal insuline resistnace and tha pancreatic beta islet cells are unable to produce sufficient insulin -> can develop GDM

Question 8

how does pre-exisiring diabetes affect the fetus

Answer 8

can cause increased rates of fetal congennital abnormalites
eg cardiac defects, NTDs and renal abnormalties

*-good control pre-conception decreases risk

Question 9

how does maternal hyperglycaemia cause macrosomia in the fetus

*-what risks are associated with macrosomia

Answer 9

glucose crosses placenta- insulin does not
-fetus produces own insulin for 10 weeks

increased maternal glucose= increased fetak glucose-> increased insulin production-> macrosomia

*-increased risk of intrauterine death: (chronic hypoxia and acidaemia) and increased oxygen demands

labour and delivery may be complicated by shoulder dystocia

Question 10

how does fetus insulin requirments change by trimester

Answer 10

1st trimester- static or decrease

2nd - increase

3-increase- reduces slighlt towards term

Question 11

complications of diabetes in pregnnacy for mother 9

Answer 11

infections- UTI in particular

Macrovasulacr aterial disease

coronary artery disease, cerebrovasuclar disease, peripheral vascular disease

microvascular disease

retinopathy, nephropathy, neuropathy

DKA

if pre-exisiting diabetes- increased reitnopathy risk

pre-eclampsia increased risk

risk of polyhydramnios

Question 12

specific risks of pre-exisiting diabetes for pregnnacy 4

Answer 12

miscarriage

congenital malformation

stillbirth

neonatal death

Question 13

neonatal implications of diabetes in pregnancy 8

Answer 13

hypoglycaemia

hypocalcaemia

hyperbilirubinaemia/ polycythaemia

idopathic RDS

delayed lung maturity

prematuriry

predisoposition to obesity and diabetes later in life

Question 14

points of preconception care for women with diabtes planning to get pregnant 6

Answer 14

avoid unplanned pregnacies

offer pre-conception care and advice to women before discontinuing contraception

GOOD GLYCAEMIC CONTROL IS ESSENTIAL

explain the risks and how to reduce them

diet, body weight and excerssie

organise pre-pregnancy retinal and renal assessment

Question 15

how does prengnacy managemnt differ in a. women with pre-exisiting diabetes 2

Answer 15

pregnancy assocaited hypoglycaemia and reduced hypoglycaemic awareness

pregnancy related N/V and glycaemic control

Question 16

what are pre-pregnacy glucose targets for diabetic women 4

Answer 16

fasting plasma glucose 5-7mmol/L on waking

plasma glucose 4-7 before meals at any time

HbA1c under 48

avoid pregnancy if HbA1c >86

Question 17

how are risks of diabetic complications reudced in women with pre-exisiting diabtes 2

Answer 17

good glycaemic control
-medication review
-glycaemic targets
-self-monitoring routine

folic acid supplements (5mg/day)
-for 3 months perception until 12 weeks gestation

Question 18

when is planned deilivery in. a women with gestational diabetes

Answer 18

37+0 - 38+6 weeks

reduces risk of still birth and shoulder dystocia w no increase C section risk

Question 19

postpartum manaegmtn of women with diabetes 2

Answer 19

encourage bresat feedign- early and regular

RAPID reduction of insulin requirement - usually back to pre-pregnacy insulin regime immediately after delivery

Question 20

who is tested for gestational diabetes (5), when and with what test

Answer 20

at 24-28wks a 2hour 75g OGTT for anyone with:

-BMI above 30
-previous macrosomic baby weighting 4.5kg or above
-previous gestational diabetes
-Fhx of diabetes (1st° degree relative)
-minority ethinc family rogine with high prevalence of diabetes

Question 21

using a 2hr 75g OGTT what value defines gestational diabetes 2

Answer 21

fasting plasma > 5.6mmol/l
or
2-hour plasam >7.8 mmol/l

Question 22

what will good glucose control reduce the risk of in pregnancy 5

Answer 22

fetal macrosomia

trauma during birth for both

induction of labour and/or C section

neonatal hypoglycaemia

perinatal death

Question 23

antenatal manaegmnt of gestational diabetes 3

Answer 23

diet and exercise

metformin, glibenclamid, insulin

adivse delivery no later than 40+6

Question 24

intrapartum managemtn of gestational diabets 2

Answer 24

aim for maternal gluocse between 4-7

may not require sliding scale

Question 25

post partum management of gestational diabetes 3

Answer 25

stop all treatment & offer lifestyle advice

6week fasting glucose ± HbA1c

annual review community
-USUALLY RECURRS IN FUTURE PREGNANCY