T2 L19Maternal Hyperglycaemia During Pregnancy

Question 1

what are the 2 scenarios with maternal hyperglycaemia

Answer 1

• Type 1 Diabetes
• Type 2 Diabetes
• -Known
• -Unknown
• Monogenic Diabetes
• Impaired Glucose Tolerance (IGT)

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

Question 2

what is gestational diabetes

Answer 2

Diabetes OR Impaired Glucose Tolerance

75g Fasting glucose =/ > 5.6 mmol/l
2 hour GTT glucose =/ > 7.8 mmol/l

Question 3

what problems can occur in the first trimester

Answer 3

• Hydrocephalus
• Meningomyelocoele
• Central Cyanosis in Congenital Heart disease
• Single Ventricle &Sacral Dysgenesis
• Renal Agenesis

Question 4

how do you prevent congenital malformations

Answer 4

Good Diabetes Control in 1st Trimester

Prepregnancy counselling

Lifestyle
Modification

Intensive glucose monitoring

Optimize Insulin Regimen

Folic Acid 5mg / day

Question 5

what are the risk factors to fetal malformation due to maternal hyperglycaemia

Answer 5

Previous Gestational Diabetes

Obesity

Polycystic ovarian syndrome

Family history of type 2 diabetes

High risk racial group

Insulin resistance

Dyslipaemia

Hypertension

Vascular disease

Question 6

what problems can occur in the 3rd trimester

Answer 6

1) Macrosomia
2) Difficult Birth
3) Shoulder Dystocia
4) Breathing Problems

5) Jaundice
6) Hypoglycaemia

Question 7

how is gestational diabetes controlled

Answer 7

Fasting glucose < 5.1 mmo/l
1 hour postprandial glucose < 7 mmol/l
Fetal Abdominal girth < 70th centile
Less in Asians

Question 8

How do you treat gestational diabetes

Answer 8

Prepregnancy /1st trimester
hyperglycaemia

Basal bolus Insulin
regimen

“Gestational” diabetes

• Metformin
• Basal Insulin
• Basal bolus Insulin
• Glibenclamide (Uncommon in UK)

Question 9

how do you manage post partum

Answer 9

Maintain good Glycaemic control

• To prevent excess glucose in milk
• Reduce maternal weight gain

Advice re next pregnancy

Contraception advice

Encourage long term glycemic control

Encourage Breast Feeding

Question 10

screening

Answer 10

Screen to detect “Gestational diabetes”

-High risk women at 12-14 weeks
-At 28 weeks
Everyone ( Universal screening ) or
Targeted (NICE)

Postpartum Screen “GDM women” for Diabetes

• At 12 week post Partum
• Annually for Diabetes (50% by 15 years)

Question 11

early vs late problems

Answer 11

Early - Teratogenesis

Late :
-Macrosomia / hypoglycaemia / lung problems

• Pre-eclampsia
• Late Fetal death