Flashcards in High-Risk Pregnancy Part 1 Deck (82)
Babies born to mothers with diabetes have been conditioned to high levels of glucose and therefore have high basal levels of insulin. This puts them at risk of what complication at delivery?
Babies born to diabetic mothers are at risk of what long-term complications?
Obesity and diabetes
Foetal hypoxia which occurs as a result of hypoglycaemia at birth leads to erythropoiesis and polycythaemia- this in turn leads to what clinical sign?
What are the three main maternal complications associated with diabetes in pregnancy?
Miscarriage, pre-eclampsia and polyhydramnios
Other than neonatal hypoglycaemia, what are the three main foetal complications associated with diabetes in pregnancy?
Congenital anomalies, intra-uterine death and macrosomia/shoulder dystocia
Screening for gestational diabetes is carried out when? What test is used for this?
OGTT at 24-28 weeks
What are the screening options for women who have had gestational diabetes in a previous pregnancy?
OGTT at booking, or self-monitoring of blood glucose levels
What are the four biggest risk factors for the development of gestational diabetes?
Previous macrosomic baby or gestational diabetes, BMI > 30, first degree relative with diabetes, ethnic origin with a high prevalence
Gestational diabetes can be diagnosed if a woman has a fasting glucose of what?
5.6mmol/L or more
Gestational diabetes can be diagnosed if a woman has a 2-hour OGTT glucose of what?
7.8mmol/L or more
For those with pre-existing diabetes, what is the target HbA1c pre-pregnancy?
Pregnancy is not advised in women with an HbA1c of more than what?
How long should folic acid be given for pre-conception in women with pre-existing diabetes? What dose is given?
3 months, 5mg
What are some medications, commonly used in diabetic patients, which should be stopped pre-pregnancy?
Statins and ACE inhibitors
Screening for which complications of diabetes must always be done, ideally pre-pregnancy, but definitely in early pregnancy, for those with pre-existing diabetes?
Retinopathy and nephropathy
In women with diabetes, after the 18-20+6 week foetal anomaly scan, how often are growth scans carried out?
Every 4 weeks from 28 weeks
If a woman is diagnosed with gestational diabetes and she has a fasting blood glucose of < 7mmol/l, what is the first line management?
Trial of diet and exercise
What are two oral hypoglycaemic agents which can be used in pregnancy in women with type 2 or gestational diabetes?
Metformin and glibenclamide
If insulin treatment is required in pregnancy, what regimen should ideally be used?
Basal bolus regimen
How are type 2 diabetics managed during pregnancy?
Oral hypoglycaemic agents, except metformin, are stopped and insulin is commenced
If a woman is diagnosed with gestational diabetes and glucose targets are not met within 1-2 weeks of diet and exercise management, what should be done next?
What medication is offered to women with gestational diabetes who cannot tolerate metformin or who fail to meet the glucose targets with metformin but decline insulin treatment?
If a woman is diagnosed with gestational diabetes and the fasting blood glucose is 7mmol/l or more, what treatment is offered?
If a woman is diagnosed with gestational diabetes and the fasting blood glucose is 6-6.9mmol/l and there is evidence of complications, what treatment is offered?
What treatment are women with pre-existing diabetes given in pregnancy in order to try and prevent the development of pre-eclampsia?
75mg aspirin from 12 weeks
Mothers with diabetes are delivered of their baby by what gestation?
Macrosomic babies in diabetic mothers are delivered by C-section to reduce the risk of what complication?
Women with gestational diabetes stop all medication immediately after delivery. What follow-up do they receive and why?
Fasting blood glucose is checked at 6 weeks to screen for underlying type 2 diabetes
Hypertension, with or without proteinuria, which is present before pregnancy or < 20 weeks gestation is defined as what?