Diabets and pregnacy Flashcards
What does diabetes in pregnancy incoperate
GDM, T1DM & T2DM
T2DM prevalence increasing
prevalence of diabetes in pregnacy
5% pregnancies affected by diabetes
87.5% of these are GDM
cuase of T1dm and who gtets it
organ specific auto-immune disease
young, slim, european
cause of T2DM and who gets it
strong genetic component
-peripheral insuline ressitance
older and fatter
-ethniciity important
glucose physiological changes in pregnancy 4
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
what causes hyperglycaemia in pregnancy
placenta produces human placental lactogen
-this increases insulin resistance and human chorionic somatomammotrophin which increases production of insulin
basic pathophys of gestational diabetes
maternal insuline resistnace and tha pancreatic beta islet cells are unable to produce sufficient insulin -> can develop GDM
how does pre-exisiring diabetes affect the fetus
can cause increased rates of fetal congennital abnormalites
eg cardiac defects, NTDs and renal abnormalties
*-good control pre-conception decreases risk
how does maternal hyperglycaemia cause macrosomia in the fetus
*-what risks are associated with macrosomia
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
how does fetus insulin requirments change by trimester
1st trimester- static or decrease
2nd - increase
3-increase- reduces slighlt towards term
complications of diabetes in pregnnacy for mother 9
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
specific risks of pre-exisiting diabetes for pregnnacy 4
miscarriage
congenital malformation
stillbirth
neonatal death
neonatal implications of diabetes in pregnancy 8
hypoglycaemia
hypocalcaemia
hyperbilirubinaemia/ polycythaemia
idopathic RDS
delayed lung maturity
prematuriry
predisoposition to obesity and diabetes later in life
points of preconception care for women with diabtes planning to get pregnant 6
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
how does prengnacy managemnt differ in a. women with pre-exisiting diabetes 2
pregnancy assocaited hypoglycaemia and reduced hypoglycaemic awareness
pregnancy related N/V and glycaemic control
what are pre-pregnacy glucose targets for diabetic women 4
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
how are risks of diabetic complications reudced in women with pre-exisiting diabtes 2
good glycaemic control
-medication review
-glycaemic targets
-self-monitoring routine
folic acid supplements (5mg/day)
-for 3 months perception until 12 weeks gestation
when is planned deilivery in. a women with gestational diabetes
37+0 - 38+6 weeks
reduces risk of still birth and shoulder dystocia w no increase C section risk
postpartum manaegmtn of women with diabetes 2
encourage bresat feedign- early and regular
RAPID reduction of insulin requirement - usually back to pre-pregnacy insulin regime immediately after delivery
who is tested for gestational diabetes (5), when and with what test
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
using a 2hr 75g OGTT what value defines gestational diabetes 2
fasting plasma > 5.6mmol/l
or
2-hour plasam >7.8 mmol/l
what will good glucose control reduce the risk of in pregnancy 5
fetal macrosomia
trauma during birth for both
induction of labour and/or C section
neonatal hypoglycaemia
perinatal death
antenatal manaegmnt of gestational diabetes 3
diet and exercise
metformin, glibenclamid, insulin
adivse delivery no later than 40+6
intrapartum managemtn of gestational diabets 2
aim for maternal gluocse between 4-7
may not require sliding scale
post partum management of gestational diabetes 3
stop all treatment & offer lifestyle advice
6week fasting glucose ± HbA1c
annual review community
-USUALLY RECURRS IN FUTURE PREGNANCY
