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Laura MRCOG Part 2 > 9) Maternal Medicine: Diabetes > Flashcards

9) Maternal Medicine: Diabetes Flashcards

1
Q

Incidence of diabetes in pregnancy

A

5% of pregnancies

  • 87.5% GDM
  • 7.5% T1DM
  • 5% T2DM
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2
Q

Contraindications to pregnancy in diabetes

A
  • IHD
  • HbA1c > 86
  • Severe gastroparesis
  • Untreated proliferative retinopathy
  • Nephropathy (Cr > 250)
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3
Q

At what BMI should you advise weight loss pre-conceptually?

A

27

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4
Q

Glucose control whilst planning pregnancy

A

Monthly HbA1c and aim for <48.

Fasting BM 5-7mmol/L
Pre-meal 4-7mmol/L at other times

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5
Q

Screening at pre-conception counselling

A

HbA1c
Retinal screening if not done in last 6 months
Renal screening - if Cr >120, ACR>30 or eGFR<45 then refer nephrology.

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6
Q

Who to screen for GDM?

A 
BMI >30
Previous baby >4.5kg
Previous GDM
1st degree relative DM
Ethnic minority with high risk
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7
Q

What glycosuria to test for GDM?

A

2+ on one occasion or 1+ on two occasions.

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8
Q

When to test for late onset GDM?

A

If EFW > 4kg or AC >90th or growth velocity increase or polyhydramnios.

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9
Q

Diagnosis of GDM on OGTT

A

Fasting >5.6

2h >7.8

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10
Q

What percentage of people with GDM will require treatment?

A

10-20%

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11
Q

What treatment in GDM?

A

If initial fasting <7 then start with diet for 1-2 w and if targets not met then look at metformin.

Insulin if:

  • Fasting >7
  • Fasting 6-7 but macrosomia
  • Not tolerating metformin
  • Targets not achieved with metformin

Consider glibenclamide if:

  • Not controlled with metformin and declining insulin
  • cannot tolerate metformin
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12
Q

How often to monitor blood sugars in diabetes?

A

T1DM or T2DM/GDM with multiple dosing insulin regimen: Check 8 times per day.

T2DM/GDM with diet/oral/single dose insulin: Check 6 times per day.

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13
Q

Blood sugar targets during pregnancy

A

Fasting: 5.3
1h post-meal: 7.8
2h post-meal: 6.4

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14
Q

When to do HbA1c?

A

At booking for pre-existing diabetes and at diagnosis for GDM. Consider in 2nd/3rd trimester for pre-existing diabetes (to predict risk).

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15
Q

When to do retinal assessment?

A

Pre-conception (if not done in 6m prior)
Booking (if not done in 3m prior)
Repeat at 28 weeks
(Repeat at 16-20 weeks if retinopathy present at booking)

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16
Q

When to do renal assessment?

A

At booking if not in preceding 3 months.

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17
Q

When to deliver in diabetes?

A

37-38+6 weeks: T1DM/T2DM

Uncomplicated GDM by 40+6

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18
Q

When to monitor BM in labour?

A

Hourly (targets 4-7)

19
Q

When to consider sliding scale in labour?

A

If persistently not maintained 4-7 and consider for T1DM at start of labour

20
Q

WHen should neonatal blood sugar done?

A

2-4 hours

21
Q

When should neonate be fed?

A

Within 30 minutes of birth and then every 2-3 hours until feeding maintains BM >2

(If BM<2 on 2 occasions consecutively then consider tube feeding or IV dextrose)

22
Q

Risk of developing T2DM after GDM

A

50% by 5years

23
Q

When to monitor BM in GDM postnatal?

A

Check BM before transfer to community care.

Fasting blood glucose or HbA1c 6-13 weeks:

  • If <6 (<39), moderate risk T2DM - annual check
  • If 6-7, high risk T2DM
  • > 7 (>48), likely T2DM already.

Then annual HbA1c.

24
Q

What percentage of pregnant women using insulin pump?

A

20% of those with pre-existing diabetes

25
Q

Diagnostic criteria for DKA

A

Ketones >3 or ++
Blood sugar >11 or known diabetes
Bicarbonate <15 or pH<7.3

26
Q

Treatment of DKA

A
  • Normal Saline
  • 10% dextrose at 125ml/h if BM<14
  • Insulin 0.1unit/kg/h (once K >3.3)
  • Add K+ if K+<5.5
27
Q

Metabolic targets in DKA

A
  • Decrease blood ketones by 0.5mmol/L/h
  • Increased venous bicarbonate by 3mmol/L/h
  • Decreased capillary glucose by 3mmol/L/h
28
Q

Fetal and maternal mortality associated with DKA

A

20% fetal

15% maternal

29
Q

How long can it take for CTG to normalise after resolution of DKA

A

4-8 hours

30
Q

Percentage of diabetics with hypoglycemic unawareness in pregnancy

A

10%

31
Q

Risk of DKA

A

3%

32
Q

Increased risk of PET

A

3-4 x

33
Q

Risk of PET if nephropathy and hypertension

A

30%

34
Q

Risk of nephropathy

A

7%

35
Q

Risk of retinopathy

A

2x

36
Q

Risk of miscarriage

A

4%

37
Q

Risk of stillbirth

A

3%

38
Q

Risk of macrosomia

A

25%

39
Q

Growth problems in DM?

A

Macrosomia or IUGR

40
Q

Neonatal metabolic consequences

A

Neonatal hypoglycaemia, low calcium, increased bilirubin, polycythaemia

41
Q

Increased risk of congenital abnormalities in DM

A

4-5x

42
Q

Risk of CS in DM

A

60%

43
Q

Increased risk of GDM with chronic steroid use

A

5-10x increased

44
Q

Inheritance DM

A

5-6% T1DM

10-15% T2DM

Laura MRCOG Part 2 (56 decks)

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