Pregnancy and diabetes Flashcards
Types of pre-gestational hyperglycaemia
Type 1 DM
Type 2 DM
Monogenic diabetes
Impaired glucose tolerance
Gestational diabetes definition
Abnormality glucose tolerance test after 1st trimester of pregnancy
WHO/ NICE criteria for GDM
Fasting glucose >5.6
2 Hour > 7.8
Guidelines infer that only pregnant women with risk factors for GDM should be screened.
Internal criteria for GDm
After 75 g glucose tolerance
Fasting 5.1
1 hr- 10
2 hrs- 8.5
Hyperglycaemia defined if 1 or more is abnormal
Maternal hyperglycaemia problems in the first trimester
Fetal malformation
- Teratogenesis dysregulation
Abnormal placental programming
- Pre-eclampsia
- XC glucose transport
Fetal malformations in first trimester maternal hyperglycaemia [6]
Hydrocephalus
Meningomyelocele (Spina bifida)
Congenital cyanotic heart disease
Single ventricle
Sacral dysgenesis
- Sacrum hasn’t develop properly
Renal agenesis
Maternal hyperglycaemia problems in the third trimester
XS fat deposition
Adverse fetal programming
Pre-pregnancy counselling
Commenced before conceiving/ 1st trimester.
Lifestyle
Intensive glucose monitoring
Optimal insulin regimen/ start insulin
Folic acid 5mg/ day
Primary care intervention in prevention of hypoglycaemic caused fetal malformation
Identifying high risk patients with DM and
- Previous GDM
- Obesity
- PCOS
- FHx T2 DM
- Ethnicity
Problems associated with maternal hyperglycaemia in the 3rd trimester
Macrosomia
- Delivery problems
Perinatal mortality
Macrosomia
Baby of large birth weight
Complication of maternal hyperglycaemia
Consequences
- Delivery problems (Shoulder dystocia)
- Breathing problems
- Jaundice
- Hypoglycaemia
Lifelong fetal sequele from maternal hyperglycaemia
Obesity
Insulin resistance
T2 DM
Hypertension
Dyslipidaemia
Vascular disease
Treatment of pregnancy hyperglycaemia
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
Targets for treatment in maternal hyperglycaemia
Fasting glucose < 5.1
1 hr post-prandial< 7
Fetal abdominal girth < 70 centile
Drug treatments
Pre-pregnancy/ first trimester
- Basal bolus insulin
Gestational
- Metformin
- Basal insulin/ basal bolus
- Glibenclamide (sulfonyurea)
Post-partum control of diabetes
Glycaemic control to prevent XC glucose in milk
Reduction in maternal weight gain
Advice for next pregnancy
Appropriate contraceptive advice
Breast feeding controlled
Breastfeeding and obesity
Any type of breastfeeding reduces risk of obesity by 30-50%
- Prolonged= 67%
Reduces post-partum weight gain in mother
Specific GDM management post-partum
Screen diabetes 12 weeks post-artum
- HbA1c
- Fasting/ GTT
Review GAD/ antibodies
- T1 DM screen
Lifestyle advice
Advice for next pregnancy
Annual glucose screening
