DM_Pregnancy Flashcards
What is diabetes?
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin (Type 1) or when the body cannot effectively use the insulin it produces (Type 2), leading to hyperglycemia.
What are the classifications of hyperglycemia in pregnancy?
Diabetes Mellitus in Pregnancy (DIP) and Gestational Diabetes Mellitus (GDM). GDM is any degree of glucose intolerance with onset or first recognition during pregnancy.
What is the incidence of diabetes mellitus in pregnancy?
Diabetes Mellitus occurs in 2-10% of all pregnancies. GDM accounts for about 90% of all cases, Type 2 DM for 8%, and Type 1 DM for approximately 1%.
What are the high-risk factors for diabetes mellitus in pregnancy?
GOLD SUGAR: GDM history, Obesity, Late maternal age, Diabetes in family, Sugar in urine, Unusual glucose levels, Giant baby, Androgen excess, Resistance to insulin.
What are the low-risk factors for diabetes mellitus in pregnancy?
SLIM: Small age (<25 years), Low BMI, Infrequent in ethnicity, Minimal obstetric issues.
What are the effects of pregnancy on pre-existing diabetes mellitus?
IN PHD: Increased insulin requirement, Neuropathy worsens, Progression of retinopathy, Hypoglycemia, Hyperglycemia, Diabetic ketoacidosis (DKA).
What are the maternal effects of pre-existing diabetes mellitus on pregnancy?
MILE: Miscarriage risk increases, Infections, LSCS rate increases, Eclampsia risk increases.
What are the fetal effects of pre-existing diabetes mellitus on pregnancy?
CAPS: Congenital abnormalities, Antepartum death, Perinatal mortality, Structural defects.
How does carbohydrate metabolism change during pregnancy?
Early Pregnancy: Increased insulin sensitivity, enhanced glucose storage, lower fasting glucose. Second half: Increased insulin resistance, higher blood glucose, shift toward fat metabolism.
What are the clinical features of diabetes mellitus in pregnancy?
Symptoms include polyuria, polydipsia, polyphagia, excessive thirst, weight loss, and complications like coma, seizure, and impaired vision. Some may be asymptomatic.
What are the maternal complications of diabetes mellitus in pregnancy?
Maternal complications include diabetic retinopathy, nephropathy, neuropathy, chronic hypertension, coronary artery disease, preeclampsia, hyperglycemia, infections, thromboembolism, and maternal mortality.
What are the fetal complications of diabetes mellitus in pregnancy?
Fetal complications include respiratory distress syndrome, hypoglycemia, polycythemia, jaundice, hypocalcemia, hypomagnesemia, hypothermia, macrosomia, birth trauma, congenital abnormalities, and increased perinatal mortality.
When does screening for gestational diabetes mellitus occur?
At 24-28 weeks of gestation. Repeat screening at 34 weeks if needed.
What are the WHO criteria for diagnosing diabetes mellitus?
Fasting plasma glucose =7.0 mmol/L, 2-hour plasma glucose =11.1 mmol/L after a 75g oral glucose load, Random plasma glucose =11.1 mmol/L with symptoms, HbA1C =6.5%.
What are the criteria for diagnosing gestational diabetes mellitus?
Fasting plasma glucose 5.1-6.9 mmol/L, 1-hour post 75g glucose load =10 mmol/L, 2-hour post 75g glucose load 8.5-11.0 mmol/L.
What are the principles of diabetes mellitus treatment in pregnancy?
Preconceptional care, glucose monitoring, dietary adjustments, exercise, discontinuation of teratogenic medications, prenatal vitamins, regular self-monitoring of blood glucose.
What are the nutritional recommendations for diabetes mellitus in pregnancy?
Based on BMI, glycemic control, and nutritional assessment. Typically 40% carbs, 40% fat, 20% protein with 3 meals + 2-3 snacks.
What are the goals in managing diabetes mellitus in pregnancy?
Achieve normoglycemia, prevent ketosis, ensure maternal and fetal health.
What investigations are carried out for diabetes mellitus in pregnancy?
Glycemic control, eye exam for retinopathy, renal function tests, thyroid function tests.
What medications are used for diabetes mellitus in pregnancy?
Insulin is preferred (0.7 IU/kg in 1st trimester, 1 IU/kg later). Metformin and glyburide may be used.
What antenatal care is given to pregnant women with diabetes mellitus?
First trimester: Viability ultrasound, routine labs, urine culture. Second trimester: Fetal anomaly scan (18-22 weeks), echocardiography. Third trimester: Fetal growth assessment, NST, fetal kick count.
What are the methods of screening for gestational diabetes mellitus?
One-step screening (75g OGTT) or two-step screening (50g glucose challenge test followed by 75g or 100g OGTT).
What are the target blood sugar levels during pregnancy and delivery?
Pregnancy: Pre-prandial =5.3 mmol/L, 1-hour postprandial =7.8 mmol/L, 2-hour postprandial =6.7 mmol/L. Delivery: 4-7 mmol/L. HbA1C target <7%.
When is delivery planned for gestational diabetes and pre-existing diabetes mellitus?
Delivery planned at 38-39 weeks. Induction at 39 weeks unless contraindicated. C-section if fetal weight >4500g.
What oral hypoglycemic agents are used in pregnancy?
Metformin and glyburide, mainly used in the 2nd and 3rd trimesters due to safety concerns.
What are the caloric intake guidelines in pregnancy based on pre-pregnancy BMI?
Underweight BMI <18.5: 35-40 kcal/kg, Normal BMI 18.5-24.9: 30-35 kcal/kg, Overweight BMI 25-29.9: 25-30 kcal/kg, Obese BMI =30: Reduce intake but not below 1600-1800 kcal/day.
