T2 L2: Maternal hyperglycaemia during pregnancy

Question 1

What is gestational diabetes defined as?

Answer 1

Diabetes or impaired glucose tolerance causing a fasting glucose of >5.6mmol/l or 2 hour glucose of >7.8mmol/l

Question 2

How does the maternal metabolic system change as the pregnancy develops?

Answer 2

Early pregnancy is facilitated anabolism

• Increased insulin sensitivity
• Glucose concentration is slightly higher
• Increased maternal energy stores

Later pregnancy is facilitated catabolism

• Increased insulin resistance
• Increased transplacental passage of nutrients causing rapid foetal growth

Question 3

What is anabolism?

Answer 3

The synthesis of complex molecules in living organisms from simpler ones together with the storage of energy; constructive metabolism.

Question 4

How does maternal hyperglycaemia mess with the mother and child during the 1st trimester?

Answer 4

Increased foetal abnormalities Eg. hydrocephalus, meningomyelocele, congenital heart disease, single ventricle, sacral dysgenesis, renal agenesis

Abnormal placental programming leading to increased risk of pre-eclampsia and excessive glucose transport

Question 5

What is pre-eclampsia?

Answer 5

High blood pressure during pregnancy and after labour

Question 6

What is a meningomyelocele?

Answer 6

When a sac that contains spinal fluid pushes through the gap in the spine

Question 7

What is sacral dysgenesis?

Answer 7

Abnormal development of the lower spine

Question 8

How is foetal malformation in maternal hyperglycaemia prevented?

Answer 8

Good diabetes control and folic acid 5mg/day

Question 9

What is macrosomia?

Answer 9

Babies born larger than average

Question 10

What are the problems with macrosomia?

Answer 10

• Difficult birth
• Shoulder dystocia
• Breathing problems
• Jaundice
• Hypoglycaemia
• Death (sometimes sudden)

Question 11

What problems does hyperglycaemia during pregnancy cause for the mother in the future?

Answer 11

• Obesity
• Insulin resistance
• Type 2 diabetes
• Dyslipaemia
• Hypertension
• Vascular disease

Question 12

What is screened for to detect the risk of gestational diabetes?

Answer 12

• Previous gestational diabetes
• Obesity
• Family history
• High risk racial groups
• Older age
• PCOS

Question 13

When does gestational diabetes screening happen?

Answer 13

At 26-28 weeks and its universal

Question 14

What is the treatment for hyperglycaemia during pregnancy?

Answer 14

• Good maternal control of glucose
• Appropriate nutrition
• Reasonable exercise
• Ultrasound monitoring of foetal abnormalities every month from week 28
• Maternal observation of foetal movements

Question 15

What are the tests for hyperglycaemia?

Answer 15

Fasting glucose: <5.1 mmol/l
1 hour postprandial glucose: <7mmol/l
Foetal abdominal girth: <70th centile

Question 16

What is the drug treatment for gestational diabetes?

Answer 16

Basal bolus of insulin regimen

Metformin

Question 17

What advice is given to the mother after a hyperglycaemic pregnancy?

Answer 17

• Encourage breast feeding
• Maintain good glycaemic control to prevent excess glucose in milk and to reduce maternal weight gain
• Encourage long-term glycaemic control