Pregnancy and diabetes

Question 1

How does maternal metabolism change as pregnancy progresses?

Answer 1

Early pregnancy: facilitated anabolism, increased insulin sensitivity, slightly lower glucose concentration, increased maternal energy stores.
Later pregnancy: facilitated catabolism, increased insulin resistance, increased transplacental passage of nutrients > rapid foetal growth.

Question 2

How does maternal hyperglycaemia affect the first trimester?

Answer 2

Increased foetal abnormalities - fuel mediated teratogenesis.
Abnormal placental programming - increased risk of pre-eclampsia, excessive glucose transport.

Question 3

Which foetal conditions can arise due to maternal hyperglycaemia?

Answer 3

hydrocephalus, meningomyelocoele, central cyanosis in congenital heart disease, single ventricle and sacral dysgenesis, renal agenesis.

Question 4

How can foetal malformation due to hyperglycaemia during pregnancy be prevented?

Answer 4

Good diabetes control in 1st trimester: prepregnancy counselling - lifestyle modification, intensive glucose monitoring, if not on insulin commence insulin optimise insulin regimen - basal bolus or pump.
folic acid 5mg / day
aspirin

Question 5

How can hyperglycaemia in the third trimester affect the baby?

Answer 5

Macrosomia > difficult birth, shoulder dystocia.

Breathing problems, jaundice, hypoglycaemia.

Question 6

What are the potential life-long consequences for the foetus as a result of hyperglycaemia during pregnancy?

Answer 6

Obesity, insulin resistance, type 2 diabetes, dyslipaemia,

hypertension, vascular disease

Question 7

What are the risk factors for gestational diabetes?

Answer 7

Early Screening for high risk women:

previous GDM, obesity (BMI > 30), family history, high risk racial group, older age, polycystic ovary syndrome.

Question 8

How is hyperglycaemia during pregnancy treated?

Answer 8

Good maternal glucose control: intensive blood glucose monitoring e.g. finger prick tests or freestyle libre.
Appropriate nutrition
Reasonable exercise
Ultrasound monitoring of fetal abdominal girth - monthly from 28 weeks.
Maternal observation of fetal movements.

Question 9

What is used to treat prepregnancy/1st trimester hyperglycaemia?

Answer 9

Basal bolus insulin regimen

Question 10

Which drugs are used to treat gestational diabetes?

Answer 10

Metformin, basal insulin, basal bolus insulin