Pregnancy and diabetes Flashcards
Why does diagnosing maternal hyperglycaemia matter?
Opportunity to prevent
- morbidity in the offspring
- an exacerbation of obesity and type 2 diabetes epidemic
- future type 2 diabetes in the mother
2 groups of woman at ANC
Women with normal glucose tolerance
Women with abnormal glucose tolerance
- known diabetes or IGT
- unknown diabetes of IGT
Pre-gestational hyperglycaemia: possible scenarios
Type 1 diabetes
Type 2 diabetes
Monogenic diabetes
Impaired glucose tolerance
Gestational diabetes
Any newly found abnormal GTT after the 1st trimester of pregnancy
WHO definition of gestational diabetes
Diabetes or impaired glucose tolerance
- fasting glucose > 5.6 mmol/l
- 2 hour GTT glucose >7/8 mmol
IADPSG criteria of hyperglycaemia of pregnancy
75g glucose tolerance test
- fasting 5.1 mmol/l
- 1 hour 10.0 mmol/l
- 2 hours 8.5 mmol/l
Diagnose if 1 or more abnormal
Problems during 1st trimester
Increased foetal abnormalities
- fuel mediated teratogenesis
e.g. hydrocephalus, meningomyelocoele, central cyanosis in congenital heart disease, single ventrical and sacral dysgenesis, renal agenesis
Preventing foetal malformations in hyperglycaemia of pregnancy
Good diabetes control in 1st trimester
Prepregnancy counselling
- lifestyle modification
- intensive glucose monitoring
- optimise insulin regimen
- if not on insulin commence insulin
Folic acid 5mg/ day
Risk factors of unknown cases of diabetes
Previous gestational diabetes
Obesity
Polycystic ovarian syndrome
Family history of type 2 diabetes
High risk racial group
Maternal metabolism changes as pregnancy progresses
Early pregnancy = facilitated anabolism
- increased insulin sensitivity
- glucose concentration slightly lower
- increased maternal energy stores
Later pregnancy = facilitated catabolism
- increased insulin resistance
- increased transplacental passage of nutrients
- rapid fetal growth
Problems in 3rd trimester
Macrosomia and associated problems
Pre eclampsia
Foetal or neonatal death
Breathing problems
Jaundice
Women with diabetes vs no diabetes perinatal mortality
Type 2 diabetes x 9
Type 1 diabetes x 4
Lifelong foetal sequele
Obesity
Insulin resistance
Type 2 diabetes
Dyslipidaemia
Hypertension
Vascular disease
Screening for high risk women
Previous GDM
Obesity
Family history
High risk racial group
Older age
Polycystic ovary system
Treatment of any pregnancy hyperglycaemia
Good maternal glucose control
- intensive blood glucose monitoring
Appropriate nutrition
Reasonable exercise
Ultrasound monitoring of foetal abdominal girth
Maternal observation of foetal movements
