Module 4: Diabetes in the perinatal period Flashcards
Diabetes definition and classifications
A clinical syndrome characterised by hyperglycemia due to deficiency or diminished effectiveness of insulin.
Type 1
Type 2
Gestational diabetes mellitus
Gestational diabetes: definition and incidence
A woman who is diagnosed of glucose intolerance with onset or first recognition during pregnancy.
Incidence: 5% of pregnancies
Effects of diabetes in pregnancy
Women with type 1 and 2 generally have an alteration to the progression of the disease
Increased risk of ketosis and infection
Higher risk of IOL, preterm birth, caesarean section, hypertension and hospitalisation
Fetal metabolism
The fetus receives glucose from the placenta by facilitate diffusion
Fetus produces insulin from 9 weeks
increased maternal blood glucose lead to hyperinsulinemia and macrosomia
Type 1 IDDM management
Ideally pre-conceptual care
Team approach - endocrinologist, obstetrician, midwives, diabetes educator and dietician
Education and self-monitoring of blood glucose levels
Insulin therapy
Type 1 diabetes process
The pancreas stops making insulin because of beta cell destruction, without insulin the body’s cells cannot turn glucose into energy. Body utilizes its own fats as a substitute for glucose.
Unless treated with insulin, chemical substances accumulate in the blood = ketoacidosis
Purpose of monitoring diabetes
To maintain blood glucose levels
To reduce the risk of long term complications
What is HbA1c, and ideal number
Measures long term glucose control - by measuring the percentage of Hb that is glycosylated (attached to sugar) and reflects the average blood glucose during the preceding 1-2 months.
Should be <7%
Insulin requirements during pregnancy for Type 1 diabetes
First trimester - often need a reduction of insulin due to transfer of glucose to fetus and reduction in dietary intake
Second trimester - increase in diabetogenic effects of hormones causes an increase in insulin requirements. Increase risk of ketogenesis
Last 3-4 weeks insulin needs plateau or decrease, and this increases the risk of hypoglycemia and stillbirth
Complications of diabetes during pregnancy
Ketoacidosis
Hypoglycaemia
Microvascular
Macrovascular
Urinary and vaginal infections
Spontaneous miscarriage
Pre-eclampsia
Infection
Preterm labour
Caesarean section
Fetal complications of diabetes
Stillbirth
Neonatal mortality
Congenital abnormalities
Respiratory distress syndrome
LGA
Hypoglycaemia
Hyperbilirubinaemia
Type 2 diabetes explanation
Insulin resistance at the tissue level. The body either makes too little insulin or is unable to use the insluin it makes
Risk factors for GDM
Obesity, BMI >30
Previous macrocosmic baby >4.5 kg
Previous GDM, family history of GDM
Maternal age >25
ATSI, Middle Eastern or Asian ethnicity
Previous unexplained stillbirth
Poor obstetric or social history.
When does screening for GDM occur
Everyone at 24-28 weeks
OR
At risk population
Criteria of diagnosis of GDM
If one or more of the following criteria are met:
a) Fasting plasma >7.0mmol/L
b) 2 h plasma glucose >11.1 mmol/l following a 75g oral glucose load
c) a random plasma glucose 11.1 mmol/l in the presence of diabetes symptoms
