Pregnancy and Diabetes

Question 1

Types of pre-gestational hyperglycaemia

Answer 1

Type 1 Diabetes
Type 2 Diabetes

Monogenic Diabetes

Impaired Glucose Tolerance (IGT)

Question 2

What is gestational diabetes

Answer 2

Any newly found Abnormal GTT after the 1st trimester of pregnancy

Question 3

WHO/NICE criteria for GDM

Answer 3

Fasting glucose >5.6

2hr >7.8

Question 4

IADPSG criteria for GDM

Answer 4

After 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

Question 5

Maternal Hyperglycaemia

-1st trimester problems

Answer 5

Fetal malformation
-Teratogenesis

Abnormal placental programming

• Increased risk of Pre-eclampsia
• Excessive glucose transport

Question 6

Fetal Malformation due to maternal hyperglycaemia

Answer 6

• Hydrocephalus
• Meningomyelocoele
• Central Cyanosis in Congenital Heart disease
• Single Ventricle
• Sacral Dysgenesis- sacrum not developed properly
• Renal agenesis

Question 7

Pre-pregnancy counselling

Answer 7

• Lifestyle Modification
• Intensive glucose monitoring
• Optimize Insulin Regimen
• If not on Insulin commence Insulin

Folic acid 5mg/day

Question 8

Primary care intervention

-Who is at high risk of developing diabetes?

Answer 8

• previous GM
• Obesity
• PCOS
• FH of T2 diabetes
• Ethnicity

Question 9

What can macrosomia?

Answer 9

Large birth weight

due to maternal hyperglycaemia

Consequences 
-Difficult Birth
Shoulder Dystocia
-Breathing Problems 
-Jaundice
-Hypoglycaemia

Question 10

Lifelong Fetal Sequele due to maternal hyperglycaemia

Answer 10

• obesity
• insulin resitance
• T2 DM
• Hypertension
• Dyslipidaemia
• Vascular Disease

Question 11

Treatment of Pregnancy Hyperglycaemia

Answer 11

• Good maternal glucose control
• Appropriate nutrition
• Reasonable exercise
• Utrasound monitoring of Fetal abdominal girth
• Maternal observation of Fetal movements