Flashcards in Obesity and Diabetes in pregnancy Deck (14)
Name 3 consequences of maternal obesity on the foetus
Neural tube defects
Stillbirth and perinatal death
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
Prolonged labour, failure to progress
Increased C/S rate
More post-op infections
VTE, preterm birth and dyslipidaemia have not shown significant correlations with maternal obesity
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
Name 5 effects of diabetes on the pregnant mother
Increased risk of:
Infection (UTI, chorioamnionitis)
PPH (from polyhydramnios/macrosomia)
Name 5 effects of diabetes on the foetus
Congenital abnormalities (cardiac, neural tube, cleft lip)
Name 5 effects of diabetes on the neonate
Increased risk of diabetes
What hypogylaemic medication is safe to use in pregnancy? What common medication isn't safe?
Insulin safe to use. Sulfonylurea not safe to use
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
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)
How do you manage a diabetic woman having a vaginal delivery?
Anticipate shoulder dystocia
Watch for PPH
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
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
What are the cutoffs for GDM?
Fasting > 5mmol/L
1 hr after glucose tolerance test (75g glucose) > 10
2hr > 8.5