Diabetes in pregnancy Flashcards
Drug management of pre-existing DM (2)
Stop oral hypoglycaemics except metformin
Commence insulin
Folic acid recommendations in DM
5mg/day conception to 12 weeks
Pathophysiology of gestational diabetes
Inability of beta cells to compensate for increased insulin resistance in pregnancy
Risk factors for GDM (4)
Obesity
Previous macrosomic baby
Previous GDM
1st degree relative with DM
Who should be screened for GDM? (2)
Patients with Hx of GDM
Patients with risk factors
How is GDM screening carried out?
OGTT close to booking appointment; if normal, repeat at 24-48 weeks
Diagnostic values for GDM
a) fasting
b) 2-hour OGTT
a) >= 5.6mmol/l
b) >=7.8mmol/l
In GDM when should a trial of diet and exercise be offered?
When fasting glucose
When should metformin and insulin be offered? (3)
If diet + exercise trial fails to control BM
if there are evidence of complications
If initial fasting glucose >7mmol/l
Self-monitoring targets in diabetes n pregnancy:
a) fasting
b) two-hour post prandial
a) 5.3
b) 6.4
Maternal complications of diabetes in pregnancy (3)
Polyhydramnios
Pre-eclampsia risk
Pre-term labour
Neonatal complications of diabetes in pregnancy (5)
Increased malformation risk Neonatal hypoglycaemia Shoulder dystocia Macrosomia Respiratory distress syndrome
Percentage of GDM patients who go on to develop T2DM
About 50%
When should a fasting glucose test be offered post-partum?
6-13 weeks
