Diabetes Mellitus in Pregnancy

Question 1

What is diabetes mellitus?

Answer 1

A chronic condition where the body fails to produce or use insulin properly, leading to hyperglycaemia.

Question 2

How does hyperglycaemia occur in pregnancy?

Answer 2

Due to insulin resistance or increased insulin demand during pregnancy.

Question 3

What are the classifications of hyperglycaemia in pregnancy?

Answer 3

Diabetes in Pregnancy (DIP) and Gestational Diabetes Mellitus (GDM).

Question 4

What defines gestational diabetes mellitus (GDM)?

Answer 4

Hyperglycaemia first recognised during pregnancy.

Question 5

What is the incidence of diabetes mellitus in pregnancy?

Answer 5

Occurs in 2–10% of pregnancies; 90% are GDM.

Question 6

Name high-risk factors for diabetes in pregnancy.

Answer 6

Previous GDM, obesity, age ≥ 40, PCOS, macrosomia history, glycosuria, FHx.

Question 7

List low-risk factors for diabetes in pregnancy.

Answer 7

Age < 25, normal BMI, low-risk ethnic group, no poor obstetric history.

Question 8

How does pregnancy affect pre-existing diabetes mellitus?

Answer 8

Worsens glycaemic control, may increase insulin needs, risk of DKA and retinopathy.

Question 9

How does pre-existing diabetes affect pregnancy?

Answer 9

Increased miscarriage, pre-eclampsia, infections, C-section risk, foetal anomalies.

Question 10

What are the key hormonal contributors to insulin resistance in pregnancy?

Answer 10

Human placental lactogen, oestrogen, progesterone, cortisol.

Question 11

Explain the pathophysiology of foetal macrosomia in diabetic mothers.

Answer 11

Maternal glucose crosses placenta → fetal hyperinsulinaemia → fat storage & macrosomia.

Question 12

List 5 foetal complications of diabetes in pregnancy.

Answer 12

Macrosomia, congenital anomalies, stillbirth, polyhydramnios, birth trauma.

Question 13

List 5 neonatal complications of diabetes in pregnancy.

Answer 13

Hypoglycaemia, RDS, jaundice, cardiomegaly, polycythaemia.

Question 14

List 5 maternal complications of diabetes in pregnancy.

Answer 14

Retinopathy, nephropathy, infections, PIH, thromboembolism, maternal mortality.

Question 15

What symptoms are associated with hyperglycaemia?

Answer 15

Polyuria, polydipsia, polyphagia, weight loss, thirst, fatigue.

Question 16

What is the WHO 2013 diagnostic criteria for diabetes in pregnancy?

Answer 16

FPG ≥ 7.0 mmol/L, 2hr OGTT ≥ 11.1 mmol/L, RPG ≥ 11.1 mmol/L + symptoms, HbA1c ≥ 6.5%.

Question 17

What is the diagnostic range for GDM (fasting, 1-hour, 2-hour)?

Answer 17

FPG 5.1–6.9, 1-hour ≥10.0, 2-hour 8.5–11.0 mmol/L.

Question 18

What is the standard time for routine screening of GDM?

Answer 18

At 24–28 weeks, earlier if high-risk, and repeat at 34 weeks if needed.

Question 19

What is the two-step screening approach for GDM?

Answer 19

Step 1: 50g GCT → Step 2: 75g or 100g OGTT if GCT abnormal.

Question 20

What are the target glucose levels during pregnancy and labour?

Answer 20

Pregnancy: Pre-prandial ≤ 5.3 mmol/L, 1hr ≤ 7.8, 2hr ≤ 6.7 mmol/L. Labour: 4–7 mmol/L.

Question 21

What HbA1c target is recommended in pregnancy?

Answer 21

<7%, ideally <6.5% without hypoglycaemia.

Question 22

What are the components of lifestyle management for GDM?

Answer 22

Medical Nutrition Therapy (MNT), exercise, weight control.

Question 23

How are calories allocated based on BMI?

Answer 23

35–40 kcal/kg for underweight, 30–35 for normal, 25–30 for overweight women.

Question 24

Describe healthy carbohydrate intake in GDM.

Answer 24

Low-GI, high-fibre foods; avoid sugars, juices, processed carbs.

Question 25

What forms of exercise are safe during pregnancy with diabetes?

Answer 25

Moderate exercise like walking, limited upper-body resistance training.

Question 26

When is pharmacotherapy indicated in GDM?

Answer 26

If lifestyle modifications fail or macrosomia risk appears.

Question 27

What is the gold standard therapy for diabetes in pregnancy?

Answer 27

Insulin therapy.

Question 28

Which oral hypoglycaemics are commonly used in pregnancy?

Answer 28

Metformin, Glyburide (with caution).

Question 29

What insulin regimen is used in pregnancy?

Answer 29

MDI (split regimen) or CSII (pump).

Question 30

What is Continuous Subcutaneous Insulin Infusion (CSII)?

Answer 30

Pump delivering rapid-acting insulin continuously.

Question 31

Why is psychosocial support important in diabetic pregnancy?

Answer 31

To reduce stress, fear, and improve glucose control and outcomes.

Question 32

How is labour and delivery planned for women with diabetes?

Answer 32

Induction at 38–39 weeks if macrosomic or poor control; CS if >4000g.

Question 33

When is post-delivery OGTT recommended?

Answer 33

At 6–12 weeks postpartum.

Question 34

What are the components of a structured approach to management?

Answer 34

Preconception → Trimester-specific care → Delivery → Postpartum.

Question 35

What should be done in the first trimester for diabetic pregnancy?

Answer 35

Early referral, dating scan, screen for complications, hypoglycaemia education.

Question 36

What are the goals of second trimester management?

Answer 36

Glycaemic control, congenital scan, monitor fetal growth & wellbeing.

Question 37

What are the main focus areas in the third trimester?

Answer 37

Delivery planning, monitor glycaemia, fetal health assessments.