Pregnancy

Question 1

which types of diabetes can occur in pregnancy?

Answer 1

type 1
type 2
GDM

Question 2

what week does foetal organogenesis start?

Answer 2

week 5

Question 3

complications in pregnancy for type 1 and 2

Answer 3

congenital malformation
prematurity
intra-uterine growth retardation

Question 4

complications in pregnancy for those with GDM

Answer 4

macrosomia (90th centile for size)- consider delivery

polyhydramnios and intrauterine death

Question 5

complications in the neonate

Answer 5

respiratory distress (immature lungs)
hypoglycaemia (fits)
hypocalcaemia (fits)

Question 6

what can maternal hyperglycaemia lead to?

Answer 6

foetal hyperglycaemia as it passes through the placenta. This leads to foetal hyperinsulinemia and when born causes macrosomia and neonatal hypoglycaemia

Question 7

what does the foetus produce in the 3rd trimester

Answer 7

insulin which acts as a growth factor

Question 8

management for type 1 and 2 diabetes

Answer 8

• prepregnancy counselling (good control of sugar pre-conception as limits risks of congenital malformation)
• folic acid 5mg
• consider change from tablets to insulin
• regular eye checks as there is accelerated retinopathy (10/20/30 weeks gestation)
• avoid ACEI and statin, for BP use labetalol, nifedipine and methyldopa
• start aspirin 150mg at 12 weeks (high risk pregnancy)

Question 9

management for all three types of diabetes in pregnancy

Answer 9

diabetic diet
aim for good blood sugar control e.g. <4-5.5mmol/L and 2hr post-meal <6.5-7mmol and monitor HbA1c and BP
maintain good blood glucose during labour e.g. IV insulin and dextrose

Question 10

management of GDM

Answer 10

lifestyle, then metformin and insulin as last resort

Question 11

what happens in management of GDM after pregnancy

Answer 11

6-week post-natal fasting glucose or GTT to ensure resolution, if not they have type 2 diabetes

Question 12

is there increased risk of developing diabetes after having GDM

Answer 12

yes (more type 2, especially if obese)