DM (established disease) in pregnancy

Question 1

DM - epi

Answer 1

1-2%

Question 2

DM - complications (fetus)

Answer 2

1. Miscarriage
2. Congenital abnormalities (e.g. neural tube defects)
3. Preterm labour
4. Polyhydramnios
5. Macrosomia

Question 3

DM - complications (neonate)

Answer 3

1. Polycythaemia, jaundice
2. Hypoglycaemia
3. Hypothermia
4. Birth trauma - shoulder dystocia
5. RDS

Question 4

DM - complications (mother)

Answer 4

1. UTI
2. Candidiasis
3. Gestational hypertension/pre-eclampsia
4. Operative deliveries - CS, assisted vaginal
5. Retinopathy

Question 5

DM - pre-pregnancy counselling

Answer 5

1. Aim for optimal BGL control; contraception until this is achieved
2. Assess severity of diabetes
3. Educate pt on complications
4. General health - SNAP + good BMI
5. Folic acid 5mg

See pre-pregnancy counselling for more info

Question 6

DM - antenatal care

Answer 6

1. Multidisciplinary team with endocrinologist
2. BGL control normoglycaemia, monitor 4x/d. Can give insulin as SC injections 2 or 4x/d, or as continuous infusion (no better than injections)
3. HbA1c every month (objective measurement of control over preceding 2mo)
4. Dietitian review (low sugar, low fat, high fibre diet with low glycaemic index)
5. Scans - anomaly scan and fetal echo

Question 7

DM - labour

Answer 7

1. Induce labour at 38-39 weeks if no maternal/fetal complications
2. Vaginal delivery preferred, consider elective CS if EFW>4.5kg
3. BGL if diet controlled - check BGL hourly (if high, give insulin)
4. BGL if insulin-dependent - SC insulin until established labour, then sliding scale
5. Post-partum - baby to SCN, needs early feeding