Maternal diabetes

Question 1

Physiology in pregnancy

Answer 1

1. Women becomes more resistant to insulin due to increased secretion of human placental lactogens/glucagon/cortisol
2. Glucose handling is more erratic - loses ability to regulate glucose levels smoothly, lower fasting levels and higher post prandial levels
3. Renal threshold for glucose changes - glycosuria on urinalysis

Question 2

Pre existing diabetes effects in pregnancy

Answer 2

1. increased dose of insulin
2. More hypos/diabetic ketacidosis
3. Accelerate complications - diabetic retinopathy/nephropathy

Question 3

Management of diabetes in pregnancy

Answer 3

1. Commence with 5 mg folic acid prior to trying for pregnancy
2. Dietary advice - low fat and high fibre diet
3. Home blood glucose monitoring and clinic HbA1c
4. Increasing insulin doses and fundoscopy for comp
5. Scans for growth and liquor

Question 4

Complications of diabetes in pregnancy

Answer 4

1. miscarriage
2. Fetal congenital abnormality
3. Proteinuric hypertension
4. Macrosomia/Shoulder dystocia - exposure to high levels of fetal insulin like growth factor
5. Polyhydraminos - fetal polyuria
6. Candida/UTI - due to glucosuria

Question 5

Fetal risks in maternal diabetes

Answer 5

1. Hypoglycaemia
2. Respiratory distress
3. Jaundice

Question 6

Gestational diabetes

Answer 6

high glucose blood levels in the second or early third term of pregnancy

Question 7

Risk factors of gestational diabetes

Answer 7

• past history of gestational diabetes
• previous macrosomic baby
• family history of diabetes

Question 8

Diagnosis of gestational diabetes

Answer 8

1. May be offered blood glucose testing if risk factors are present
2. ‘Large for date’ pregnancy with macrosomia or polyhydrominos
3. Recurrent utis or glycosuria
4. in retrospect of still birth baby who was macrosomic and had hypoglycaemia