Maternal Diabetes (pre-existing DM)

Question 1

What percentage of pregnant women have pre-existing DM?

Answer 1

~0.4%

Question 2

What is the most common type of pre-existing diabetes in pregnancy?

Answer 2

Type 1

Question 3

Is pre-existing type 2 diabetes becoming more or less common in pregnancy?

Answer 3

More common

Question 4

What women are more commonly affected by pre-existing diabetes?

Answer 4

Older, more obese and unplanned pregnancies

Question 5

Which type of pre-existing diabetes has a higher rate of complications in pregnancy?

Answer 5

Both the same

Question 6

What are the implications of pregnancy on pre-existing diabetes?

Answer 6

• Anti-insulin effects of placental hormones
• Vomiting in early pregnancy can complicate diet and medication balance
• Reduced ‘warning signs’ of hypoglycaemia
• Can accelerate retinopathy and nephropathy

Question 7

What is the result of the anti-insulin effects of placental hormones in pre-existing diabetes in pregnancy?

Answer 7

Up to 3x larger insulin requirement

Question 8

What are the implications of pre-existing diabetes on pregnancy in the first trimester?

Answer 8

• Increased rate of miscarriage

- Increased risk of congenital abnormality

Question 9

What is the risk of miscarriage due to pre-existing diabetes related to?

Answer 9

Glycaemic control

Question 10

What congenital defects does pre-existing diabetes increase the risk of?

Answer 10

• Neural tube defects

- Congenital heart disease

Question 11

What is the risk of fetal abnormality in women with HbA1c >10 %?

Answer 11

25%

Question 12

What are the implications of pre-existing diabetes on pregnancy in the second trimester?

Answer 12

• Pre-eclampsia
• Macrosomia
• Polyhydramnios

Question 13

What other things can increase the risk of pre-eclampsia besides pre-existing diabetes?

Answer 13

• Hypertension

- Diabetic nephropathy

Question 14

What are the implications of pre-existing diabetes in the third trimester of pregnancy?

Answer 14

• Still birth

- Growth restriction

Question 15

When may women with pre-existing diabetes be likely to develop fetal growth restriction?

Answer 15

With pre-existing vascular disease or pre-eclampsia

Question 16

What are the implications of pre-existing diabetes on labour?

Answer 16

• Increased need for induction of labour
• Poor progress of labour
• Pre-term delivery

Question 17

What are the implications of pre-existing diabetes on delivery?

Answer 17

• Increased risk of instrumental birth or need for C-section

- Shoulder dystocia

Question 18

What are the postnatal implications of pre-existing diabetes?

Answer 18

• Neonatal hyperglycaemia
• Respiratory distress syndrome
• Jaundice

Question 19

What is important before in conception in pre-existing diabetes?

Answer 19

Counselling to inform women of the implications on pregnancy

Question 20

What should be aimed for before conception in pre-existing diabetes?

Answer 20

HbA1c <6.1%

Question 21

Why is a low HbA1c desirable before conception in pre-existing diabetes?

Answer 21

Because complications are often related to glycaemic control

Question 22

Is insulin safe in pregnancy?

Answer 22

Yes

Question 23

Is metformin usually continued in pregnancy?

Answer 23

Yes

Question 24

Are other oral hypoglycaemics usually continued in pregnancy?

Answer 24

No

Question 25

What medication that may treat complications of diabetes may not be safe in pregnancy?

Answer 25

ACE inhibitors

Question 26

What supplement should women with pre-existing diabetes take increased doses of pre-conception?

Answer 26

Folic acid

Question 27

Who may be involved in an obstetric diabetes clinic?

Answer 27

- Obstetrician - Endocrinologist - Diabetes specialist nurse - Dietician - Specialist midwife

Question 28

What is the goal of treating pre-existing diabetes in pregnancy?

Answer 28

Keep blood glucose as close to normal as possible whilst avoiding hypoglycaemia

Question 29

What is often required in order to achieve the aims of controlling pre-existing diabetes in pregnancy?

Answer 29

- More frequent capillary blood glucose monitoring | - Tighter control

Question 30

How is fetal well-being measured in pre-existing diabetes in pregnancy?

Answer 30

Fetal assessment for abnormalities

Question 31

What abnormality assessments may be given to a fetus of a pregnant woman with pre-existing diabetes?

Answer 31

- Combined test for chromosomal abnormalities - Routine anomaly scan at 20 weeks - Additional scanning for cardiac abnormality - Regular serial growth scans

Question 32

Why are regular serial growth scans useful in fetus of a pregnant woman with pre-existing diabetes?

Answer 32

To detect macrosomia and fetal growth restriction

Question 33

How can maternal wellbeing be increased in women with pre-existing diabetes in pregnancy?

Answer 33

- Low-dose aspirin from second trimester - Keep BP low in women with vascular disease - Ophthalmic assessment each trimester

Question 34

What can low dose aspirin from the second trimester do for women with pre-existing diabetes in pregnancy?

Answer 34

Reduce the risk of pre-eclampsia

Question 35

Where should women with pre-existing diabetes give birth?

Answer 35

Hospital with neonatal facilities

Question 36

When is delivery usually recommended in pre-existing diabetes?

Answer 36

38-39 weeks

Question 37

How doe C-section rates compare to non-diabetics in women with pre-existing diabetes?

Answer 37

Higher

Question 38

When do post-natal women with pre-existing diabetes return to pre-pregnancy treatment?

Answer 38

As soon as delivered and eating and drinking