Maternal Diabetes (pre-existing DM) Flashcards
What percentage of pregnant women have pre-existing DM?
~0.4%
What is the most common type of pre-existing diabetes in pregnancy?
Type 1
Is pre-existing type 2 diabetes becoming more or less common in pregnancy?
More common
What women are more commonly affected by pre-existing diabetes?
Older, more obese and unplanned pregnancies
Which type of pre-existing diabetes has a higher rate of complications in pregnancy?
Both the same
What are the implications of pregnancy on pre-existing diabetes?
- 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
What is the result of the anti-insulin effects of placental hormones in pre-existing diabetes in pregnancy?
Up to 3x larger insulin requirement
What are the implications of pre-existing diabetes on pregnancy in the first trimester?
- Increased rate of miscarriage
- Increased risk of congenital abnormality
What is the risk of miscarriage due to pre-existing diabetes related to?
Glycaemic control
What congenital defects does pre-existing diabetes increase the risk of?
- Neural tube defects
- Congenital heart disease
What is the risk of fetal abnormality in women with HbA1c >10 %?
25%
What are the implications of pre-existing diabetes on pregnancy in the second trimester?
- Pre-eclampsia
- Macrosomia
- Polyhydramnios
What other things can increase the risk of pre-eclampsia besides pre-existing diabetes?
- Hypertension
- Diabetic nephropathy
What are the implications of pre-existing diabetes in the third trimester of pregnancy?
- Still birth
- Growth restriction
When may women with pre-existing diabetes be likely to develop fetal growth restriction?
With pre-existing vascular disease or pre-eclampsia
What are the implications of pre-existing diabetes on labour?
- Increased need for induction of labour
- Poor progress of labour
- Pre-term delivery
What are the implications of pre-existing diabetes on delivery?
- Increased risk of instrumental birth or need for C-section
- Shoulder dystocia
What are the postnatal implications of pre-existing diabetes?
- Neonatal hyperglycaemia
- Respiratory distress syndrome
- Jaundice
What is important before in conception in pre-existing diabetes?
Counselling to inform women of the implications on pregnancy
What should be aimed for before conception in pre-existing diabetes?
HbA1c <6.1%
Why is a low HbA1c desirable before conception in pre-existing diabetes?
Because complications are often related to glycaemic control
Is insulin safe in pregnancy?
Yes
Is metformin usually continued in pregnancy?
Yes
Are other oral hypoglycaemics usually continued in pregnancy?
No
What medication that may treat complications of diabetes may not be safe in pregnancy?
ACE inhibitors
What supplement should women with pre-existing diabetes take increased doses of pre-conception?
Folic acid
Who may be involved in an obstetric diabetes clinic?
- Obstetrician
- Endocrinologist
- Diabetes specialist nurse
- Dietician
- Specialist midwife
What is the goal of treating pre-existing diabetes in pregnancy?
Keep blood glucose as close to normal as possible whilst avoiding hypoglycaemia
What is often required in order to achieve the aims of controlling pre-existing diabetes in pregnancy?
- More frequent capillary blood glucose monitoring
- Tighter control
How is fetal well-being measured in pre-existing diabetes in pregnancy?
Fetal assessment for abnormalities
What abnormality assessments may be given to a fetus of a pregnant woman with pre-existing diabetes?
- Combined test for chromosomal abnormalities
- Routine anomaly scan at 20 weeks
- Additional scanning for cardiac abnormality
- Regular serial growth scans
Why are regular serial growth scans useful in fetus of a pregnant woman with pre-existing diabetes?
To detect macrosomia and fetal growth restriction
How can maternal wellbeing be increased in women with pre-existing diabetes in pregnancy?
- Low-dose aspirin from second trimester
- Keep BP low in women with vascular disease
- Ophthalmic assessment each trimester
What can low dose aspirin from the second trimester do for women with pre-existing diabetes in pregnancy?
Reduce the risk of pre-eclampsia
Where should women with pre-existing diabetes give birth?
Hospital with neonatal facilities
When is delivery usually recommended in pre-existing diabetes?
38-39 weeks
How doe C-section rates compare to non-diabetics in women with pre-existing diabetes?
Higher
When do post-natal women with pre-existing diabetes return to pre-pregnancy treatment?
As soon as delivered and eating and drinking
