Gestational Diabetes

Question 1

What is diabetes in pregnancy?

Answer 1

Pre existing or new onset diabetes in pregnancy.

Question 2

What is the aetiology of diabetes in pregnancy?

Answer 2

Pre existing Type 1 or type 2 see notes.

Gestational DM: altered glucose tolerance in pregnancy only.

Question 3

What are the RFs of diabetes in pregnancy?

Answer 3

GDM: maternal age, ethnicity south asian/caribbean, obese, smoking, PCOS, previous macrosomic baby (i.e. Beckman Widemann)

Question 4

What is the epidemiology of diabetes?

Answer 4

2-5% pregnancy, GDM accounts for 90% of DM in pregnancy.

Question 5

What is the history of diabetes?

Answer 5

PRE existing: history of diabetes.

GDM: usually asymptomatic, picked up on screening.

Question 6

What would you find in the exam of diabetes?

Answer 6

Abdomen: fundal heights (macrosomia and polyhydramnios)

Question 7

What is the pathology of diabetes?

Answer 7

T1/T2 pre exisitng see notes.

GDM: increased insulin resistance in pregnancy due to secreted insulin antagonists (i.e. HPL, glucaogn and cortisol). Altered carb metabolism, combined with failure of normal pregnancy related spike in insulin production compensating the above.

Fetus: hyperglycaema in early pregnancy changes development , fetal hyperinsulinaemia, macrosomia at birth. Hypoglycaema can then occur at birth due to the withdrawal of maternal glucose while fetal insulin levels remain high.

Question 8

What investigations do you do for diabetes?

Answer 8

Maternal screening, by GTT at week 26-28.

Pre existing Hx: obtain hx, detailed anomaly, cardiac, renal USS of baby.

Aim for delivery at 38wk, sliding scale commenced in labour.

Question 9

What is the management of diabetes?

Answer 9

Pre existing

· Pre- Conceptual optimisaiton of glucose control

· Medical optimisaiton of diet, consider converting oral hypoglycaemic to insulin.

· Pregnancy: CBG monitoring strict.

· Delivery: sliding scale in labour

· Post partum: return to pre pregnancy medicaitons and doses.

GDM:
· Diet control. If persisting, insulin tx.

· Pregnancy/delivery: as for pre existing.

· Postpartum: stop insulin, FBG 6/52 post partum.

Question 10

What are the complications/ prognosis of diabetes?

Answer 10

Maternal: progression of pre existing microvascualt (renal, eye, neuropathy) complications of diabetes.

Miscarriage, pre eclampsia, operative delivery requirement.

Fetal/neonatal: congenital abnormalities (if pre-existing), fetal death, polyhydramnios, polycythaemia, macrosomia, RDS, neonatal hypoglycaemia, neonatal jaundice.

PGX depends on control. GDM 70% recur in future pregnancies.