DM with pregnancy Flashcards
What is the effect of pregnancy on diabetes?
- repeated pregnancies is diabetogenic in predisposed patients
- may unmask latent diabetes
- diabetes is more difficult to control -> increased requirement of insulin during pregnancy & decrease after delivery
- hypoglycemia after labour due to utilization of sugar by the breast
due to increased production of insulin antagonists (human placental lactogen, placental insulinase, cortisol, estrogens, & progesterone) at 24-34 weeks
What are the complications that pregnancy impose on diabetes?
increased risk (due to lower threshold) of
- DKA
- retinopathy
- nephropathy
- neuropathy
- CVDs
What are the effects of diabetes on pregnancy?
- abortion
- pre-eclampsia
- polyhydramnios
- preterm labour
- monilia vulvo-vaginitis (increased glycogen deposition in vagina)
- infections -> UTIs, sepsis, breast abscess
- uncontrolled early -> congenital anomalies
- uncontrolled late -> fetal macrosomia (4.5kg)
What are the most common congenital anomalies that occur in a fetus with a diabetic mother in early pregnancy?
- VSD
- NTDs
- caudal regression syndrome (sacral agenesis or mermaid syndrome)
What is the cause of fetal macrosomia in uncontrolled diabetes in the second half of pregnancy?
maternal hyperglycemia will stimulate hyperinsulinism in the fetus -> enhances glycogen synthesis, lipogenesis, & protein synthesis in the fetus
What are the causes of increased incidence of neonatal mortality in uncontrolled diabetic mothers?
- Respiratory distress syndrome
- congenital anomalies
- neonatal hypoglycemia
- macrosomia -> hypocalcemia, hypomagnesemia, hyperbilirubinemia, & polycythemia
What is the cause of IUFD in the last month of pregnancy in a diabetic mother?
- ketosis
- hypoglycemia
- pre-eclampsia
- congenital anomalies
- placental insufficiency
induce labour at 38-39 weeks to avoid this
What is done for initial diagnosis of diabetes and what are the indications for it?
Blood sugar curve -> raised fasting & lagging curve
Done for
- women 35 years or more
- + family history of diabetes
- previous large babies
- previous unexplained IUFD or neonatal death
- previous 2 or more unexplained abortions
- presence or history of CFMF
- gross obesity
- hypertensive women
- polyhydramnios
- +ive urine test for sugar
- > 5 deliveries
What tests are used for screening of diabetes in pregnancy & when should they be done?
1- urinalysis -> for protein & glucose
2- Fasting blood sugar & Random blood sugar -> on 1st ANC visit (to rule out pre-gestational DM)
3- glucose challenge test -> give 50 grams of glucose & measure blood glucose after 1 hour
4- glucose tolerance test (2h-OGTT) -> measure FBS and repeat twice after administering 75 grams of glucose every hour
What do the results of the FBS & RBS indicate?
Fasting Blood Sugar
- >125 mg/dl -> pre gestational diabetes
- <125 mg/dl -> do OGTT
Random Blood Sugar
- >200 mg/dl -> pre gestational diabetes
- <200 mg/dl -> do OGTT
What do the results of the glucose challenge test indicate?
- < 140 mg/dl -> unlikely to have GDM
- 140 or more -> do OGTT
- > 180 mg/dl -> pre-gestational DM
What do the results of the glucose tolerance test (2h-OGTT) indicate?
- fasting 100 or more
- after 1 hour 180 or more
- after 2 hours 140 or more
if one or more are elevated -> diagnose GDM
How is gestational diabetes managed?
1- pre-conceptional counseling for DM
- control blood sugar
- shift to insulin if on oral hypoglycemic
- evaluate any complications of DM
2- antenatal care
- repeated blood sugar estimations to regulate dose of insulin
- B-complex
- urinalysis for sugar, acetone, & albumin
- ultrasound scanning
- HbA1C if > 6.5% -> poor diabetic control in past 2-3 months
- diet control -> 30-35 cal/kg/day
- exercise -> 3 times/week for 30-45mins
test blood sugar profile after diet & exercise -> if abnormal add insulin therapy
How is insulin therapy unit requirement calculated for a pregnant lady?
- 1 - 20 weeks -> 0.5 u/kg/day
- 20 - 25 weeks -> 0.6 u/kg/day
- 25 - 30 weeks -> 0.7 u/kg/day
- 30 - 35 weeks -> 0.8 u/kg/day
- 35 - 40 weeks -> 0.9 u/kg/day
- if total units needed is < 50 units/day -> single morning dose NPH/regular ratio 2:1
- if units needed are > 50 units/day -> 2/3rd morning & 1/3rd evening NPH/regular ratio 1:1
When is a therapeutic abortion indicated in GDM?
< 22 weeks in cases complicated by
- nephropathy >500mg proteinuria/day at <20w
- arteriosclerotic heart disease
- proliferative diabetic retinopathy or vitreous hemorrhage
- history of renal transplant
