Pregnancy and diabetes

Question 1

Types of pre-gestational hyperglycaemia

Answer 1

Type 1 DM
Type 2 DM

Monogenic diabetes

Impaired glucose tolerance

Question 2

Gestational diabetes definition

Answer 2

Abnormality glucose tolerance test after 1st trimester of pregnancy

Question 3

WHO/ NICE criteria for GDM

Answer 3

Fasting glucose >5.6

2 Hour > 7.8

Guidelines infer that only pregnant women with risk factors for GDM should be screened.

Question 4

Internal criteria for GDm

Answer 4

After 75 g glucose tolerance

Fasting 5.1
1 hr- 10
2 hrs- 8.5

Hyperglycaemia defined if 1 or more is abnormal

Question 5

Maternal hyperglycaemia problems in the first trimester

Answer 5

Fetal malformation
- Teratogenesis dysregulation

Abnormal placental programming

• Pre-eclampsia
• XC glucose transport

Question 6

Fetal malformations in first trimester maternal hyperglycaemia [6]

Answer 6

Hydrocephalus

Meningomyelocele (Spina bifida)

Congenital cyanotic heart disease

Single ventricle

Sacral dysgenesis
- Sacrum hasn’t develop properly

Renal agenesis

Question 7

Maternal hyperglycaemia problems in the third trimester

Answer 7

XS fat deposition

Adverse fetal programming

Question 8

Pre-pregnancy counselling

Answer 8

Commenced before conceiving/ 1st trimester.

Lifestyle

Intensive glucose monitoring

Optimal insulin regimen/ start insulin

Folic acid 5mg/ day

Question 9

Primary care intervention in prevention of hypoglycaemic caused fetal malformation

Answer 9

Identifying high risk patients with DM and

• Previous GDM
• Obesity
• PCOS
• FHx T2 DM
• Ethnicity

Question 10

Problems associated with maternal hyperglycaemia in the 3rd trimester

Answer 10

Macrosomia
- Delivery problems

Perinatal mortality

Question 11

Macrosomia

Answer 11

Baby of large birth weight

Complication of maternal hyperglycaemia

Consequences

• Delivery problems (Shoulder dystocia)
• Breathing problems
• Jaundice
• Hypoglycaemia

Question 12

Lifelong fetal sequele from maternal hyperglycaemia

Answer 12

Obesity

Insulin resistance

T2 DM

Hypertension

Dyslipidaemia

Vascular disease

Question 13

Treatment of pregnancy hyperglycaemia

Answer 13

Intensive blood glucose monitoring
- Check fasting, 1 hr post prandial

Nutrition

Exercise

Fetal abdominal girth monitored
- Monthly from 28 wks

Fetal movements monitored by mothers

Question 14

Targets for treatment in maternal hyperglycaemia

Answer 14

Fasting glucose < 5.1

1 hr post-prandial< 7

Fetal abdominal girth < 70 centile

Question 15

Drug treatments

Answer 15

Pre-pregnancy/ first trimester
- Basal bolus insulin

Gestational

• Metformin
• Basal insulin/ basal bolus
• Glibenclamide (sulfonyurea)

Question 16

Post-partum control of diabetes

Answer 16

Glycaemic control to prevent XC glucose in milk

Reduction in maternal weight gain

Advice for next pregnancy

Appropriate contraceptive advice

Breast feeding controlled

Question 17

Breastfeeding and obesity

Answer 17

Any type of breastfeeding reduces risk of obesity by 30-50%
- Prolonged= 67%

Reduces post-partum weight gain in mother

Question 18

Specific GDM management post-partum

Answer 18

Screen diabetes 12 weeks post-artum

• HbA1c
• Fasting/ GTT

Review GAD/ antibodies
- T1 DM screen

Lifestyle advice

Advice for next pregnancy

Annual glucose screening