Obesity and Diabetes in pregnancy Flashcards
Name 3 consequences of maternal obesity on the foetus
Neural tube defects Exomphalos Heart defects Stillbirth and perinatal death Macrosomia
Name 5 consequences of maternal obesity on the mother. Name 2 consequences that haven’t been proven to be linked with obesity.
HT and pre-eclampsia GDM Prolonged labour, failure to progress Difficult anaesthetics Increased C/S rate More post-op infections Harder breastfeeding
VTE, preterm birth and dyslipidaemia have not shown significant correlations with maternal obesity
How does pregnancy affect diabetes and management/complications?
Pregnancy = greater insulin resistance (HPL and progesterone antagonise insulin); designed to maximise blood glucose availability to foetus. Leads to greater glucose intolerance, insulin requirements, exacerbation of complications. Also increases risk of ketoacidosis and hypoglycaemia
Name 5 effects of diabetes on the pregnant mother
Increased risk of:
Pre-eclampsia Polyhydramnios Miscarriage C/S Infection (UTI, chorioamnionitis) PPH (from polyhydramnios/macrosomia)
Name 5 effects of diabetes on the foetus
Miscarriage Congenital abnormalities (cardiac, neural tube, cleft lip) Macrosomia IUGR FDIU Prematurity Shoulder dystocia
Name 5 effects of diabetes on the neonate
Hypoglycaemia Hypocalcaemia Hypomagnesaemia Polycythaemia/hyperviscosity Hyperbilirubinaemia Increased risk of diabetes Macrosomia IUGR Birth trauma
What hypogylaemic medication is safe to use in pregnancy? What common medication isn’t safe?
Insulin safe to use. Sulfonylurea not safe to use
What are the target BSL levels for a pre-existing diabetic in pregnancy (fasting and 2hrs postprandial)?
Fasting - 4-5.5 mmol/L
2 Hrs - under 7 mmol/L
How do you manage a diabetic woman going for an elective LUSCS?
First on list
Omit morning insulin
Monitor BSLs (aim for 4-7 mmol/L)
How do you manage a diabetic woman having a vaginal delivery?
Continuous CTG
Anticipate shoulder dystocia
Watch for PPH
How do you manage a postpartum diabetic woman?
Monitor BSLs closely - insulin requirements fall rapidly (err on the side of hyperglycaemia)
Avoid oral hypoglycaemics during lactation
How do you manage the neonate of a diabetic woman? Name 3 interventions for a hypoglycaemic neonate
Early feeding (within 1 hr, then every 3-4 hrs ideally) Monitor BSLs (aim above 2.6 mmol/L) Admit to special care nursery if mother had uncontrolled diabetes, or infant unwell, macrosomic, or preterm
Can use feeding, 10% dextrose IV or glucagon to raise BSL in hypoglycaemic neonate
What are the cutoffs for GDM?
Fasting > 5mmol/L
1 hr after glucose tolerance test (75g glucose) > 10
2hr > 8.5
Name a short and long-term consequence of GDM on the mother and foetus
Mother: short term - increased risk of pre-eclampsia and operative delivery. long term - higher risk of T2DM
Foetus: short term - macrosomia, death, perinatal trauma/shoulder dystocia. long term - diabetes (Barker hypothesis)
