Diabetes in pregnancy Flashcards
Give 3 fetal complications of Diabetes in pregnancy
Macrosomia + Shoulder dystocia + Neonatal hypoglycaemia
Risk of baby developing Obesity and/or Diabetes
Increase in Miscarriages + Stillbirth
Increase in congenital abnormality (pre-existing)
Give 3 maternal complications of Diabetes in pregnancy
DKA, Hypertension, Pre-eclampsia, Pre-term labour
Increased monitoring and interventions during pregnancy and labour
Obstetric intervention + Operative delivery
- Likelihood of Birth trauma, IOL and CS
What is the concern about vision and diabetes in pregnancy?
Diabetic retinopathy can worsen rapidly during pregnancy
Consequently, pre-conceptually any pre-existing diabetic retinopathy should receive treatment prior to getting pregnant.
What pre-pregnancy advice should be given to T1/T2DM and previous GDM mothers?
Use contraception until good glycaemic control is achieved (AIM <48mmol/mol)
- if HbA1C >86mmol/mol (10%) = AVOID pregnancy
- Review glycaemic targets, monitoring, medication before and during pregnancy.
- Good control before conception and throughout pregnancy will reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death.
Advice on weight loss if BMI >27 (weight loss BEFORE pregnancy – not during…)
- BMI >35 = Recommend Vitamin D supplements (Pregnacare)
Give Folic acid 5mg/day until 12 weeks + Aspirin 75mg >12 weeks gestation
STOP unsafe medications (eg statins, ACEi/ARBs, oral hypoglycaemics [except Metformin])
Retinal assessment (unless done in last 6 months)
Renal assessment (measure for microalbuminaemia before discontinuing contraceptives)
- (If eGFR<45 or Creatinine >120 refer to nephrologist)
Outline the S.A.F.E.R mnemonic for pre-conception diabetes advice
S.A.F.E.R:
Stop (medications)
A1C (is the HbA1C too high)
Folic acid (5mg + Aspirin 75mg)
Enjoy (enjoy planning your pregnancy and giving your baby a healthy start)
Referral (early referral to specialist care)
What additional scans are provided for Diabetic mothers?
4 weekly Growth + Liquor scans every 4 weeks from 28 weeks (28/32/36 weeks)
Retinal assessment at 28 weeks (if normal in first trimester)
Antenatal care 1-2 weekly (based upon control/risk factors)
At what gestation is delivery planned in pre-existing DM?
Deliver 37-38+6 weeks
o IOL = 37-38+6 weeks
o Elective CS = 38-39 weeks
Give 4 risk factors for gestational diabetes mellitus
o PMHx of GDM.
o FHx of DM (in first degree relative)
o Obesity (BMI >30kg/m2).
o Previous Macrosomic baby (>4.5kg).
o Ethnicity with high prevalence of DM (South Asia)
What is the 5, 6, 7, 8 mnemonic for Oral glucose tolerance testing?
Fasting >5.6mmol/L
2h Blood glucose (after 75g load) > 7.8mmol/L
What is the treatment for Gestational Diabetes Mellitus?
- Lifestyle advice: Weight control, Diet and Exercise. (Most women respond to it)
- Diet:
* Carbs from low glycaemic index sources
* Lean proteins including oily fish
* Balance of polyunsaturated and monounsaturated fats
* If pre-pregnancy BMI>27, advise to restrict calorie intake to 25kcal/kg/day - Metformin (up to 1g BD PO)»_space; 10-20% will need oral hypoglycaemic agents if:
- Diet and exercise fail to main BG targets during period of 1-2 weeks
- USS suggestions Fetal Macrosomia at diagnosis - INSULIN (20-30% of those started on Oral hypoglycaemics will require ADD-ON insulin)
- Novorapid {Rapid-acting}; Humulin I or Insuman basal {Long-acting}
- Start insulin immediately IF Fasting glucose >7mmol/L or suspected complications at the time of diagnosis
Aims = Regular follow up, Antenatal care with GDM clinic, Self-monitoring blood glucose
o Fetal sonography helps determine size of the baby (to diagnose fetal macrosomia – most frequent complication of GDM)
- Additional Growth & Liquor volume USS every 4 weeks after 28 weeks
At what gestation is delivery planned in uncomplicated Gestational DM?
Deliver 39-40+6 weeks (FOR UNCOMPLICATED)
- IOL = 39-40 weeks
- Elective CS >39-40+6 weeks
