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Year 4 - Obstetrics > Maternal Diabetes (pre-existing DM) > Flashcards

Maternal Diabetes (pre-existing DM) Flashcards

1
Q

What percentage of pregnant women have pre-existing DM?

A

~0.4%

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2
Q

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

A

Type 1

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3
Q

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

A

More common

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4
Q

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

A

Older, more obese and unplanned pregnancies

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5
Q

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

A

Both the same

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6
Q

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

A
  • 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
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7
Q

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

A

Up to 3x larger insulin requirement

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8
Q

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

A
  • Increased rate of miscarriage

- Increased risk of congenital abnormality

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9
Q

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

A

Glycaemic control

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10
Q

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

A
  • Neural tube defects

- Congenital heart disease

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11
Q

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

A

25%

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12
Q

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

A
  • Pre-eclampsia
  • Macrosomia
  • Polyhydramnios
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13
Q

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

A
  • Hypertension

- Diabetic nephropathy

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14
Q

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

A
  • Still birth

- Growth restriction

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15
Q

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

A

With pre-existing vascular disease or pre-eclampsia

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16
Q

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

A
  • Increased need for induction of labour
  • Poor progress of labour
  • Pre-term delivery
17
Q

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

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

- Shoulder dystocia

18
Q

What are the postnatal implications of pre-existing diabetes?

A
  • Neonatal hyperglycaemia
  • Respiratory distress syndrome
  • Jaundice
19
Q

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

A

Counselling to inform women of the implications on pregnancy

20
Q

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

A

HbA1c <6.1%

21
Q

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

A

Because complications are often related to glycaemic control

22
Q

Is insulin safe in pregnancy?

A

Yes

23
Q

Is metformin usually continued in pregnancy?

A

Yes

24
Q

Are other oral hypoglycaemics usually continued in pregnancy?

A

No

25
Q

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

A

ACE inhibitors

26
Q

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

A

Folic acid

27
Q

Who may be involved in an obstetric diabetes clinic?

A
  • Obstetrician
  • Endocrinologist
  • Diabetes specialist nurse
  • Dietician
  • Specialist midwife
28
Q

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

A

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

29
Q

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

A
  • More frequent capillary blood glucose monitoring

- Tighter control

30
Q

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

A

Fetal assessment for abnormalities

31
Q

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

A
  • Combined test for chromosomal abnormalities
  • Routine anomaly scan at 20 weeks
  • Additional scanning for cardiac abnormality
  • Regular serial growth scans
32
Q

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

A

To detect macrosomia and fetal growth restriction

33
Q

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

A
  • Low-dose aspirin from second trimester
  • Keep BP low in women with vascular disease
  • Ophthalmic assessment each trimester
34
Q

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

A

Reduce the risk of pre-eclampsia

35
Q

Where should women with pre-existing diabetes give birth?

A

Hospital with neonatal facilities

36
Q

When is delivery usually recommended in pre-existing diabetes?

A

38-39 weeks

37
Q

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

A

Higher

38
Q

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

A

As soon as delivered and eating and drinking

Year 4 - Obstetrics (61 decks)

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