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Module 203, Theme 2- Reproductive System, Fetal Development, Pregnancy and Birth > T2 L19 Pregnancy and Diabetes > Flashcards

T2 L19 Pregnancy and Diabetes Flashcards

1
Q

Why does diagnosing maternal hyperglycemia matter?

A

It affords an opportunity to prevent
-morbidity In the offspring “from the uterus to the
grave”
-an exacerbation of the obesity & Type 2 diabetes
epidemic
-future Type 2 diabetes in the mother

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2
Q

At ANC booking there are 2 groups. What are they?

A
  1. Women with Normal Glucose tolerance
  2. Women with Abnormal Glucose tolerance
    - Known Diabetes or IGT
    - Unknown Diabetes or IGT
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3
Q

What are the causes of pre-gestational hyperglycaemia?

A

Type 1 Diabetes

Type 2 Diabetes

  • known
  • unknown

Monogenic Diabetes

Impaired Glucose Tolerance (IGT)

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4
Q

What is “Gestational Diabetes”?

A

Any newly found Abnormal GTT after the 1st trimester of pregnancy ( i.e. Diabetes or IGT )

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5
Q

What is the WHO and NICE guidelines for gestational diabetes?

A

Diabetes OR Impaired Glucose Tolerance

  • Fasting glucose =/ > 5.6 mmol/l
  • 2 hour GTT glucose =/ > 7.8 mmol/l
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6
Q

What is the International Association of Diabetes & Pregnancy Study Group (IADPSG) Criteria for gestational diabetes?

A

75 g 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

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7
Q

What are the stages of pregnancy?

A

1st Trimester

  • Organogenesis
  • Carefully design the essential components
  • Avoid Mistakes ( Teratogenesis)
  • Construct & programme the placenta

2nd Trimester
-Further complex development & linkage

3rd Trimester
-Accelerated growth

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8
Q

What are the changes to maternal metabolism during early pregnancy?

A

Facilitated Anabolism

  • Increased Insulin sensitivity
  • Glucose concentration slightly lower
  • Increased maternal energy stores
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9
Q

What are the changes to maternal metabolism during late pregnancy?

A

Facilitated Catabolism

  • Increased Insulin resistance
  • Increased transplacental passage of nutrients

This leads to rapid fetal growth

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10
Q

How does maternal hyperglycaemia mess with the different stages of pregnancy?

A 
1st trimester
Increased Fetal abnormalities
  -Fuel Mediated Teratogenesis (due to increased 
   maternal blood glucose levels this leads to foetal 
   malformation)
Abnormal placental programming
  -Increased risk of Pre-eclampsia
  -Excessive glucose transport

3rd Trimester
Excessive fat deposition
Adverse Fetal programming ( epigenetics )

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11
Q

What kind of foetal malformations can maternal hyperglycaemia in the first trimester lead to?

A

Hydrocephalus

Meningomyelocoele (the child will require surgery and may not be able to walk and talk normally)

Central cyanosis (in congenital heart disease)

Single Ventricle & Sacral Dysgenesis

Renal agenesis

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12
Q

How can foetal Malformation due to maternal hyperglycaemia be prevented?

A

Good Diabetes Control in 1st Trimester

Folic Acid 5mg / day

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13
Q

How can good Diabetes Control in 1st Trimester be achieved?

A

Prepregnancy counselling

  • Lifestyle Modification
  • Intensive glucose monitoring
  • Optimize Insulin Regimen
  • If not on Insulin commence Insulin
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14
Q

What are the risk factors for unknown cases of Diabetes / IGT?

A
  • Previous Gestational Diabetes
  • Obesity (BMI >30)
  • Polycystic ovarian syndrome
  • Family history of type 2 diabetes
  • High risk racial group (Indian subcontinent- India/Paskistan, Hispanic people)
  • Older age
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15
Q

What problems in the 3rd trimester are due to maternal hyperglycaemia?

A
  • Macrosomia & associated problems
  • Pre-eclampsia
  • Fetal or Neonatal death
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16
Q

What does macrosomia (in the baby)?

A
  • Difficult Birth
  • Shoulder Dystocia
  • Breathing Problems
  • Jaundice
  • Hypoglycaemia
17
Q

What is the risk of increased perinatal mortality in T1DM and T2DM?

A

Type 2 diabetes x 9
Type 1 Diabetes x 4

NOTE: T2DM do worse perhaps due to late diagnosis in comparison to T1D

18
Q

What is the lifelong foetal sequele due to hyperglycaemia in pregnancy?

A
  • Obesity
  • Insulin resistance
  • Type 2 diabetes
  • Dyslipaemia
  • Hypertension
  • Vascular disease
19
Q

What has happened to the number of women

with diabetes during pregnancy?

A

It has more than doubled

This is a finding that raises health concerns for both mothers-to-be and babies.

20
Q

How many women are obese at their antenatal booking?

A

1 in 5

21
Q

When is screening carried out to detect GDM (gestational diabetes mellitus)?

A

Universal or Targeted Screening at 26 weeks

22
Q

How can any pregnancy hyperglycaemia be treated?

A

Good maternal glucose control
-Intensive blood glucose monitoring
Fasting + 1 hour post prandial minimum

Appropriate nutrition (the women get nutritional counselling)

Reasonable exercise (e.g. brisk walking)

Ultrasound monitoring of Foetal abdominal girth
-Monthly from 28 weeks

Maternal observation of Foetal movements

23
Q

What are the targets for hyperglycaemia in pregnancy?

A

Fasting glucose < 5.1 mmo/l

1 hour postprandial glucose < 7 mmol/l

Fetal Abdominal girth < 70th centile
-less in Asians

24
Q

How is drug treatment to achieve good maternal glucose control in pregnancy?

A

Prepregnancy /1st trimester hyperglycaemia
-Basal bolus Insulin regimen (long acting insulin
injection)

“Gestational” diabetes
  -Metformin 
  -Basal Insulin
  -Basal bolus Insulin
  -Glibenclamide (Uncommon in UK, used more in the 
   US)
25
Q

Why is maintaining good glycaemic control important post partum?

A

Prevents excess glucose in milk (which could encourage the baby to gain weight)

Reduce maternal weight gain

26
Q

What advice is given to diabetic mothers post partum?

A

Advice regarding next pregnancy

Contraception advice (people with diabetes need to plan their pregnancy until their blood glucose level is sufficiently reduced)

Encourage long term glycaemic control

Encourage Breast Feeding

27
Q

What is the effect of breast feeding on the risk of obesity in the child?

A

Any reduces risk by 30-50%

  • in 19 studies the risk is reduced by 3-19 years
  • in 6 studies the risk is reduced by 4-18 years

Prolonged exclusive reduces by 67%

28
Q

What is the effect of breast feeding on the risk of obesity in the mother?

A

Reduces post partum weight gain

29
Q

What happened to the risk of diabetes in women who lactated for a longer period?

A

Women who lactated for either 6–12 months or 12 months or longer had half the risk for diabetes

30
Q

Name “specific GDM” management methods post partum

A

Screen for diabetes at 12 weeks post partum
-HbA1c +/- Fasting glucose, or GTT

Review GAD ect. antibody status if done

Lifestyle advice

Advice re next pregnancy

  • Optimize exercise & Nutrition
  • Pre pregnancy GTT

Annual glucose screening
-50% develop type 2 diabetes at 10 years

31
Q

What contraceptive methods are used to control birth in women with diabetes?

A
  • Progestagen only pill
  • Combined OCP ( low dose) after 6 weeks
  • Mirena Intrauterine system
  • Sterilisation / Vasectomy

Module 203, Theme 2- Reproductive System, Fetal Development, Pregnancy and Birth (17 decks)

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