Pre-existing diabetes Flashcards
Fetal complications
Congenital abnormalities (related to periconceptual glucose control) Preterm labour Reduced fetal lung maturity Increased birthweight Polyhydramnios Birth trauma and dystocia Fetal distress in labour, sudden fetal death Reflex hypoglycaemia
Maternal complications
Ketoacidosis is rare Hypoglycaemia UTI Wound/endometrial infection after delivery Hypertension and pre-eclampsia Worsening of pre-existing ischaemic heart disease C-section/instrumental delivery Worsening retinopathy
Principles of management
Good glucose control and fetal monitoring
Consultant-led care, MDT approach
Patient education and patient centred approach
Preconceptual management
Assessment of renal function, blood pressure and retinae
Optimise glucose control
Folic acid 5mg/day
Labetalol or methyldopa for hypertension
Antenatal management
Fortnightly visits til 34w, then weekly Frequent BM monitoring Careful diet Insulin doses increased over pregnancy Aspirin 75mg daily reduces pre-eclampsia risk
Fetal monitoring
Fetal echocardiography
US for growth and liquor volume
Delivery
By 39 weeks
Consider elective C-section if estimated >4kg
Insulin and dextrose infusion during labour
Postnatal management
Monitor neonate for hypoglycaemia and respiratory distress
Breast feeding strongly advised
Insulin can be rapidly changed to pre-pregnant doses
Which drugs do you use?
Just metformin
Either metformin alone, or can add insulin
Other oral agents contraindicated
