Obs 3 consultant teaching

Question 1

What causes gestational diabetes?

Answer 1

The pregnancy hormones antagonise insulin action

Question 2

Why is it worrying is gestational diabetes suddenly resolves?

Answer 2

Suggests an issue with the baby’s growth

Diabetes can get under control but shouldn’t resolve until the baby is born and hormones stabilise

Question 3

What is the pre-pregnancy counselling for type 1 and 2 diabetics

Answer 3

Aim for HbA1c < 48 mmol/mol

• Stop statins/ ACEi
• Retinal & renal assessment
• Folate prescription (5mg) 3 months in advance
• Give aspirin from 12 weeks to prevent PET
• If type 2, usually put in insulin
• Lots of fetal scans
• Planned delivery for between 37-38+6 weeks

Question 4

What are the risks of macrosomnia?

Answer 4

Delay in labour at all stages (and associated maternal risk)
Shoulder dystocia
Mortality
Poor condition at birth
Neonatal hypoglycaemia

Question 5

Which type of diabetes medication is not suitable during pregnancy?

Answer 5

Gliclazide

Question 6

Who with diabetes should be advised not to conceive?

Answer 6

• Type 1 DM and HbA1c of 10.2% (88mmol/mol)
• Type 1 DM with a creatinine of 245 micromol/l

Question 7

How does BP change during pregnancy?

Answer 7

Initially falls, stabilises in the 2nd trimester usually 15mmHg lower than pre-pregnancy, and then gradually rises in 3rd trimester

Question 8

What is the definition of pre-eclampsia?

Answer 8

New onset hypertensions after 20 weeks of pregnancy and significant proteinuria

Question 9

What is HELLP syndrome?

Answer 9

A type of pre-eclampsia

Haemolysis
Elevated liver enzymes
Low platelet count

Question 10

What is the aetiology of pre-eclampsia?

Answer 10

Impaired trophoblast differentiation /invasion during the first trimester causing failure of the trophoblast cells to destroy the muscularis layer of the spiral arterioles
- Prevents normal physiological adaptation of spiral arteries to pregnancy
- Vessels don’t transform into low-resistance ones so there is reduction on blood flow to intervillous space
- Causing a poorly perfused placenta

Question 11

Who is at risk of pre-eclampsia?

Answer 11

• Hypertensive disease during a previous pregnancy
• chronic kidney disease
• autoimmune disease such as lupus or antiphospholipid syndrome
• type 1 or type 2 diabetes
• chronic hypertension
• first pregnancy
• pregnancy interval of more than 10 years
• age 40 years or older
• body mass index (BMI) of 35 kg/m2 or more at first visit
• family history of pre-eclampsia
• multiple pregnancy