Obesity and Diabetes in pregnancy Flashcards Preview

A1. Women's Health > Obesity and Diabetes in pregnancy > Flashcards

Flashcards in Obesity and Diabetes in pregnancy Deck (14):
1

Name 3 consequences of maternal obesity on the foetus

Neural tube defects
Exomphalos
Heart defects
Stillbirth and perinatal death
Macrosomia

2

Name 5 consequences of maternal obesity on the mother. Name 2 consequences that haven't been proven to be linked with obesity.

HT and pre-eclampsia
GDM
Prolonged labour, failure to progress
Difficult anaesthetics
Increased C/S rate
More post-op infections
Harder breastfeeding

VTE, preterm birth and dyslipidaemia have not shown significant correlations with maternal obesity

3

How does pregnancy affect diabetes and management/complications?

Pregnancy = greater insulin resistance (HPL and progesterone antagonise insulin); designed to maximise blood glucose availability to foetus. Leads to greater glucose intolerance, insulin requirements, exacerbation of complications. Also increases risk of ketoacidosis and hypoglycaemia

4

Name 5 effects of diabetes on the pregnant mother

Increased risk of:

Pre-eclampsia
Polyhydramnios
Miscarriage
C/S
Infection (UTI, chorioamnionitis)
PPH (from polyhydramnios/macrosomia)

5

Name 5 effects of diabetes on the foetus

Miscarriage
Congenital abnormalities (cardiac, neural tube, cleft lip)
Macrosomia
IUGR
FDIU
Prematurity
Shoulder dystocia

6

Name 5 effects of diabetes on the neonate

Hypoglycaemia
Hypocalcaemia
Hypomagnesaemia
Polycythaemia/hyperviscosity
Hyperbilirubinaemia
Increased risk of diabetes
Macrosomia
IUGR
Birth trauma

7

What hypogylaemic medication is safe to use in pregnancy? What common medication isn't safe?

Insulin safe to use. Sulfonylurea not safe to use

8

What are the target BSL levels for a pre-existing diabetic in pregnancy (fasting and 2hrs postprandial)?

Fasting - 4-5.5 mmol/L
2 Hrs - under 7 mmol/L

9

How do you manage a diabetic woman going for an elective LUSCS?

First on list
Omit morning insulin
Monitor BSLs (aim for 4-7 mmol/L)

10

How do you manage a diabetic woman having a vaginal delivery?

Continuous CTG
Anticipate shoulder dystocia
Watch for PPH

11

How do you manage a postpartum diabetic woman?

Monitor BSLs closely - insulin requirements fall rapidly (err on the side of hyperglycaemia)
Avoid oral hypoglycaemics during lactation

12

How do you manage the neonate of a diabetic woman? Name 3 interventions for a hypoglycaemic neonate

Early feeding (within 1 hr, then every 3-4 hrs ideally)
Monitor BSLs (aim above 2.6 mmol/L)
Admit to special care nursery if mother had uncontrolled diabetes, or infant unwell, macrosomic, or preterm

Can use feeding, 10% dextrose IV or glucagon to raise BSL in hypoglycaemic neonate

13

What are the cutoffs for GDM?

Fasting > 5mmol/L
1 hr after glucose tolerance test (75g glucose) > 10
2hr > 8.5

14

Name a short and long-term consequence of GDM on the mother and foetus

Mother: short term - increased risk of pre-eclampsia and operative delivery. long term - higher risk of T2DM

Foetus: short term - macrosomia, death, perinatal trauma/shoulder dystocia. long term - diabetes (Barker hypothesis)