Diabetes in pregnancy (existing before)

Question 1

What are the relations between Diabetes and pregnancy

Answer 1

Pregnancy increases insulin resistance -keeps going up during preg
This returns to normal after so adjust

Pregnancy effects on diabetes-
Nausea/Vom, big importance of tight glucose, Increase insulin resistance, Increase risk of hypo
Deteriorate retino/nephropathy

Diabetes -> preg
Increase risk of misscarriage, Risk of congenital/Spina bifida, macrosmia, pre-eclampsia, Stillbirth, Infx, Operative delivery

Question 2

What are the pre-conception tests needed for a women with diabetes-

Answer 2

Glucose control tight - 4h diary and HbA1c for risk
Renal test, BP, Retine
Stop statins, high dose folic acid

Question 3

What are the pre-conception councelling given to a women with diabetes

Answer 3

DM increase risk of misscariage
bad control is teratogenic
Growth restriction, still birth possible
Polyhydramnios
Hypo risk after baby gone
Infx and DKA

Question 4

How should a woman with known diabetes be monitored during pregnancy

Answer 4

Blood monitoring - fasting, 1h post meal and bedtime DAILY
fasting<5.3, 1h post 7.8
HbA1c is more overall risk

joint diabetes-antenatal clinic !

Timeline -
12w bookings scan
20W anomaly scan
28,32,36 -42weekly, serial

Important- if steroids needed, control becomes harder for insulin - inpatient induction

and always start sliding scale insulin during labour

Question 5

What is gestational diabetes and RF

Answer 5

New onset diabates during pregnancy -and usually dissapears after birth
occurs usually 24-28w gestation
complications same as DM in preg but lesser

RF- BMI>30, previous baby>4.5, asian. previous GDM, Fhx of diabetes

Question 6

Ix of Gestational diabetes

Answer 6

for glycosuria/previous GDM - immediate 2h 75g OGTT + hbA1c for previous DM
any RF- 2h 75g OGTT (at 24-28w)

diagnose if values -
fasting > 5,6mmol
2h OGTT > 7,8
CLUE- 5,6,7,8

if diagnosed- joint diabetes antenatal clinic within a week

Question 7

mx of Gestational diabetes before delivery

Answer 7

1st line - only if fasting BG <7- change in diet and exercise- refer to dietician

2nd - 1st line not work, <7mmol- Metformin
(if cant take metformin - straight to insulin/3rd line)

3rd line- if >7mmol - insulin alone
if <7mmol but complications- insulin alone
if 2nd line tried and fail - Insuilin + metformin

4th line - Consider Glibenclamide -
in those where metformin no work/cant tolerate

+ Glucose monitor daily - fasting, premeal (if insulin), 1h post meal, bedtime (if insulin
aim fasting < 5.3
1h post meal 7.8

CONTRAINDICATEd- GLICLAZIDE, Liraglutide

Question 8

Mx of gestational diabetes delivery/post partum

Answer 8

Delivery with GDM or DM-
Offer IOL/ELCS between 37+0 and 38+6
Delivery with sliding insulin pump
Monitor cappilary glucose -every h during labour

discontinue glucose lowering treatment immediatly after birth

Post partum- GP does fasting glucose at 6-13w post
<6 -low chance of diabates
<7 high risk
>7 50% of having T2DM -propose diagnostic tests