Obesity & Diabetes in Pregnancy Flashcards
: associated with prepregancy overweight and obesity?
Fecundity: Need for fertility treatments, recurrent miscarriges
Maternal Health: Gestational diabetes, increased risk of pre-eclampsia and Maternal Mortality
Fetal Health: Microsomia & congenital abnormalities
Obstetric Peripartum Issues: Prolonged duration of labour, Increased requirement of induction
Exomphalos, heart defects, thromboembolic disorder (controversial), more likely failure of epidural, higher chances of C section, Greater length of post operative stay, Less likely to breast feed, Less likely to be continuing breast feeding at 6 months
How would you counsel the patient? What modes of management are important to talk about?
- they require early OGTT: at 14-16 weeks
- Advise women about diet
- Early counselling with anaesthetist
- Admit to diabetes clinic, has shown to make a difference
What are the increased risks of a neural tube defect?
- Prepregnancy glucose control
- Less likely to be detect on a scan
- More likely to be on a diet
- Becomes less responsive to folic acid treatment
What is the allowable weight gain in pregnancy?
- 6.7 - 11.2 kg in overweight women
- Less than 6.7 in obese women
What are some effects of pregnancy on diabetes?
- You get increased glucose intolerance
- You can an increase in your insulin requirements
- Higher chance of retinopathy/ nephropathy
- Predisposition to ketoacidosis
- Predisposition to hypoglycaemia
What are the effects of diabetes on the pregnancy?
- Increased likely hood of pre-eclampsia, increased risk of diabetic nephropathy
- Polyhydraminos: Premature, preterm rupture of membranes
- Increased chances of miscarriage
- Higher risk of operative delivery
- Increased risk of infection such as chorioamnionitis, wound infections, UTI)
- Increased chances of PPH
What are the effects on the fetus?
Greater chances of:
- Miscarrige
- Congenital abnormalities
- Macrosomia
- Interuterine Growth Restrictions
- Fetal Death in utero
- Prematurity
- Shoulder dystocia
Diabetes increases the chances of a few different things?
- Miscarriage
- Congenital abnormalities
- Macrosomia
- IUGR
- FDIU
- Prematurity (especially if there is polyhydraminos)
- Shoulder dystocia
What are congenital abnormalities in pregnancy?
- Cardiac defects
- Neural tube defects
- Cleft lip / palate
- Caudal regression syndrome
What are the effects of Diabetes on the neonate?
- Macrosomia
- Fetal growth restriction
- Birth trauma: Shoulder dystocia, Operative delivery
- Hypoglycaemia
- Hypocalcaemia
- Hypomagnesaemia
- Polycythaemia / Hyperviscosity
- Hyperbilirubinaemia
- Respiratory distress syndrome: HMD, TTN
- Risk of diabetes
What are medications to avoid in pregnancy?
ACEI/ AT2B - causes renal defects, Interuterine growth restrictions, prematurity, persistence of PDA, severe neonatal hypotension, neonatal anuria and neonatal or fetal death
Are statins safe in pregnancy?
No statins cause malformation of the CNS and limbs
What is the target fasting and preprandial BSL range in pregnant women?
- Fasting 4.0-5.5 mol/L
- Post prandial < 7 mmol/l at 2 hrs
- Avoid hypoglycaemia and ketoacidosis
What range should the bsl be maintained at intrapartum?
- 4-7 mmol/l, avoiding hypoglycaemia and hyperglycaemia
Antenatal fetal assessments should be carried out in the setting of gestational diabetes?
Aneuploidy
- Nuchal translucency or T1 combined screening test
- Avoid a maternal serum screening test
Morphology Scan
- Normally at 18-20 weeks
- May need a repeat scan at 23 weeks to review the cardiac anatomy
Fetal growth ultrasound at 28-30 weeks, and 34 - 36 weeks, CTG, biophysical profile and dopplers
