Diabetes in Pregnancy

Question 1

Definition

Answer 1

• Can be pre-existing diabetes mellitus (type 1 or type 2)
• Gestational diabetes mellitus (GDM) = develops during pregnancy

Question 2

GDM aetiology

Answer 2

Insulin resistance due to hormonal changes and increased demand for insulin production

Question 3

Epidemiology

Answer 3

Obesity: BMI>30
Family history of diabetes
Past medical history of GDM
Advanced maternal age >40
Ethnicity: South Asian, Afro-Caribean, Middle Eastern
Previous child born large: >4.5kg

Question 4

Signs

Answer 4

Large for dates uterus

Question 5

Symptoms

Answer 5

Polydipsia
Polyuria
Fatigue
Dry mouth
Blurred vision

Question 6

Diagnosis

Answer 6

• OGTT at 24-28 weeks gestation > 7.8 mmol/L = diagnostic
• Fasting glucose >5.6 mmol/L = diagnostic
• HbA1c testing: monitor blood glucose in women with pre-existing diabetes
• Fetal USS
• Urine dip

Question 7

Treatment

Answer 7

FIRST LINE: Lifestyle modifications: offered when BG < 7.0 mmol/L
SECOND LINE: Oral anti diabetic agents: Metformin or Glibenclamide (sulfonylurea) = used when FL is insufficient after 1-2 weeks
THIRD LINE: Insulin therapy: Rapid-acting insulin. However, insulin is offered immediately if BG > 7.0 mmol/L or in any Px with GDM who has obstetric complications.

Question 8

Complications (SHAME)

Answer 8

• Shoulder dystocia
• Hypoglycaemia in neonate
• Amniotic fluid excess: polyhydramnios
• Macrosomia
• Early birth: preterm labour