Obesity Diabetes Pregnancy Flashcards
What are problems associated with pre pregnancy overweight and obesity?
- Fecundity (fertility treatments, recurrent miscarriage)
- Maternal health (gestational diabetes, pre-eclampsia, maternal mortality)
- Foetal health (macrosomia, congenital abnormalities)
- Obstetric / peripartum problems (prolonged labour, caesarean delivery)
How does obesity relate to neural tube defects and by what mechanisms?
Increased incidence. Possible mechanisms:
- pre preg glucose control
- less responsive to standard folic acid intake
- more likely to be on diets
- more likely to be missed in antenatal scans
What other congenital abnormalities are a/w maternal obesity?
- Exomphalos
- Heart defects
How does maternal weight relate to hypertensive disorders?
Every increase in pre pregnancy BMI related to an 8% increased risk of pre eclampsia
What is the effect of pregnancy on diabetes
- increase glucose intolerance
- increased insulin requirements
- exacerbation of nephropathy
- exacerbation of retinopathy
- increased predisposition to ketoacidosis
- increased predisposition to hypoglycemia
What is the effect of diabetes on pregnancy?
- Pre eclampsia
- Polyhydramnios
- Miscarriage
- Operative delivery
- Increased risk of infection
- PPH
What is the effect of diabetes on the foetus?
- Miscarriage
- Congenital abnormalities
- Macrosomia
- IUGR
- FDIU
- Prematurity
- Shoulder dystocia
What congenital abnormalities is diabetes a/w?
- cardiac defects
- neural tube defects
- cleft lip / palate
- caudal regression syndrome
Which diabetes medications should be continued in pregnancy?
- Insulins are safe
- Metformin to be considered (limited data)
Which diabetes medications should be avoided in pregnancy?
- Sulphonylurea
- Glitazones
- ACEi / ARB
- Statins
What is the effect of statins on the foetus?
-T1 effects: malformations of CNS and limb
What are the effects of ACEi and ARB on foetus?
Main in T2 + T3
- renal defects
- oligohydramnios
- IUGR
- prematurity
- persistence of PDA
- severe neonatal hypotension
- neonatal anuria
- neonatal or foetal death
Diabetes pre pregnancy counselling?
- Optimise diabetes + complications
- Review medications
- Detect and optimise other autoimmune diseases
- Folate supplementation
- Smoking cessation
- Weight loss if obese
Diabetes antenatal care?
- Frequent visits
- Multidisciplinary team
- Maintain BSLs (fasting 4-5.5; post
Intrapartum diabetes management?
- Prepare and document plan
- Regular BSLs (4-7)
- Avoid hyper / hypo
- Continuous CTG
- Anticipate shoulder dystocia
- Experience acoucher
- Watch for PPH
- If LUSCS: first on list, omit morning insulin, monitor BSLs
Post partum diabetes management?
Insulin requirements fall rapidly
• Monitor BSL’s closely
• Recomence pre-pregnancy insulin
• Avoid oral hypoglycaemic agents in lactation
• Allow mild hyperglycaemia to prevent hypoglycaemia
• Caution with hypoglycaemia with breast feeding
• Contraception
Post partum neonatal care diabetic mother?
• Early feeding
– Commence feeding within 1 hour of birth – Feed every 3-4 hrs
• Monitor BSLs
• IV glucose during labour
– infant indications:
• unwell (eg. signs of respiratory distress)
• macrosomic (> 90th centile), small for gestational age infants (
What is gestational diabetes?
-Carbohydrate intolerance with onset or first recognition during pregnancy
Intrapartum complications of obesity?
- Inc IOL / instrumental / LUSCS
- Longer first stage
- Increased FTP
- PPH
- Uterine rupture
- Shoulder dystocia
- Infection
- Difficulty monitoring FHR
- Difficulty with analgesia
VBAC more or less successful in obese?
Up to 40% less successful
Obstetric anaesthetics issues in obese mothers?
- Airway problems
- Inc risk of GA
- Positioning dificult
- Spinal/epidural failures and multiple attempts
- Inc post op risks
Post partum issues in obese mothers?
- Breastfeeding difficulties
- VTE
- Infections
- Poor wound healing
- Long term neonatal and childhood consequences
