Diabetes In Pregnancy Flashcards
(20 cards)
Describe GDM (gestational diabetes mellitus
WHO (2013) a carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy
What is the incidence of GDM
RCOG (2021) 4-5%
Describe type 1DM
Absolute lack of insulin. Autoimmune condition where the beta-cells are damaged by the immune system
What is the incidence of type 1?
8%
Describe type 2 DM
Relative lack of insulin/insulin resistance due to the partial destruction of the beta cells
What is the incidence of type 2 DM
90%
Describe Maturity onset diabetes of the young (MODY)
Autosomal dominant genetic condition. 1-2% of people with diabetes have MODY
Diagnosed aged under 25 and have 1+ parent with diabetes
What are the characteristics and symptoms of type 1 DM
Young
Hyperglycaemia (BG: >11mmols), glycosuria, ketonuria
Symptoms: weight loss, polydipsia (increased thirst), polyruria, nausea and vomiting, weakness
What are the symptoms of GDM
Polydipsia, polyuria, fatigue
What are some influencing factors of type 2 DM
Genetics, ethnicity (Asian Indian and east), previous GDM
What does NICE, 2020 advise on why would women be screened for GDM
BMI >30, prev GDM, family history of diabetes, ethnicity with a high prevalence of diabetes, glycosuria of 2+ on 1 occasion or glycosuria of 1+ on 2 or more occasions
What does UHL, 2021 say about other risk factors for GDM
Polycystic ovarian syndrome, cystsic fibrosis, accelerated fetal growth/ above 90th centile
Normal ranges for GTT
fasting is 5.6
2 hours is 7.8
Hba1c is less than 42
When should you have a GTT
previous GDM or glycosuria at booking or BMI over 45: test ASAP and at 26-28 weeks
Other risk factors: 24-28 weeks
What do NICE, 2020 and UHL, 2021 recommend intervention for an abnormal result
Refer to MDT diabetes team for a review and commence shared care
What are the interventions and monitoring of GDM
NICE, 2020- health promotion on BG stability and GDM, diet, exercise, refer to a dietician
How to monitor GDM and target ranges
Self recording using a finger prick before and 1 hour after all meals
Fasting 5.3
1 hours after 7.8 or 2 hours 6.4
If exercise and diet not effective then metformin
If metformin contraindicated or ineffective: insulin
All treatments stop PN
What is the AN care for GDM (NICE, 2020)
refer to consultant-led MDT care with diabetes team
Offer USS to assess fetal growth and liquor volume from 28-36
Ensure contact every 1-2 weeks to review BG
Planning birth for women with GDM
Uncomplicated GDM: offer IOL no later than 40+6
Fetal/maternal complications: Consider ELCS before 40+6
If IOL contraindicated offer LSCS
if IOL declined offer increased fetal monitoring in pregnancy
