Obesity Diabetes Pregnancy Flashcards Preview

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Flashcards in Obesity Diabetes Pregnancy Deck (22):
1

What are problems associated with pre pregnancy overweight and obesity?

-Fecundity (fertility treatments, recurrent miscarriage)
-Maternal health (gestational diabetes, pre-eclampsia, maternal mortality)
-Foetal health (macrosomia, congenital abnormalities)
-Obstetric / peripartum problems (prolonged labour, caesarean delivery)

2

How does obesity relate to neural tube defects and by what mechanisms?

Increased incidence. Possible mechanisms:
-pre preg glucose control
-less responsive to standard folic acid intake
-more likely to be on diets
-more likely to be missed in antenatal scans

3

What other congenital abnormalities are a/w maternal obesity?

-Exomphalos
-Heart defects

4

How does maternal weight relate to hypertensive disorders?

Every increase in pre pregnancy BMI related to an 8% increased risk of pre eclampsia

5

What is the effect of pregnancy on diabetes

-increase glucose intolerance
-increased insulin requirements
-exacerbation of nephropathy
-exacerbation of retinopathy
-increased predisposition to ketoacidosis
-increased predisposition to hypoglycemia

6

What is the effect of diabetes on pregnancy?

-Pre eclampsia
-Polyhydramnios
-Miscarriage
-Operative delivery
-Increased risk of infection
-PPH

7

What is the effect of diabetes on the foetus?

-Miscarriage
-Congenital abnormalities
-Macrosomia
-IUGR
-FDIU
-Prematurity
-Shoulder dystocia

8

What congenital abnormalities is diabetes a/w?

-cardiac defects
-neural tube defects
-cleft lip / palate
-caudal regression syndrome

9

Which diabetes medications should be continued in pregnancy?

-Insulins are safe
-Metformin to be considered (limited data)

10

Which diabetes medications should be avoided in pregnancy?

-Sulphonylurea
-Glitazones
-ACEi / ARB
-Statins

11

What is the effect of statins on the foetus?

-T1 effects: malformations of CNS and limb

12

What are the effects of ACEi and ARB on foetus?

Main in T2 + T3
-renal defects
-oligohydramnios
-IUGR
-prematurity
-persistence of PDA
-severe neonatal hypotension
-neonatal anuria
-neonatal or foetal death

13

Diabetes pre pregnancy counselling?

-Optimise diabetes + complications
-Review medications
-Detect and optimise other autoimmune diseases
-Folate supplementation
-Smoking cessation
-Weight loss if obese

14

Diabetes antenatal care?

-Frequent visits
-Multidisciplinary team
-Maintain BSLs (fasting 4-5.5; post

15

Intrapartum diabetes management?

-Prepare and document plan
-Regular BSLs (4-7)
-Avoid hyper / hypo
-Continuous CTG
-Anticipate shoulder dystocia
-Experience acoucher
-Watch for PPH
-If LUSCS: first on list, omit morning insulin, monitor BSLs

16

Post partum diabetes management?

Insulin requirements fall rapidly
• Monitor BSL’s closely
• Recomence pre-pregnancy insulin
• Avoid oral hypoglycaemic agents in lactation
• Allow mild hyperglycaemia to prevent hypoglycaemia
• Caution with hypoglycaemia with breast feeding
• Contraception

17

Post partum neonatal care diabetic mother?

• Early feeding
– Commence feeding within 1 hour of birth – Feed every 3-4 hrs
• Monitor BSLs
• IV glucose during labour
– infant indications:
• unwell (eg. signs of respiratory distress)
• macrosomic (> 90th centile), small for gestational age infants (

18

What is gestational diabetes?

-Carbohydrate intolerance with onset or first recognition during pregnancy

19

Intrapartum complications of obesity?

- Inc IOL / instrumental / LUSCS
- Longer first stage
- Increased FTP
- PPH
- Uterine rupture
- Shoulder dystocia
- Infection
- Difficulty monitoring FHR
- Difficulty with analgesia

20

VBAC more or less successful in obese?

Up to 40% less successful

21

Obstetric anaesthetics issues in obese mothers?

- Airway problems
- Inc risk of GA
- Positioning dificult
- Spinal/epidural failures and multiple attempts
- Inc post op risks

22

Post partum issues in obese mothers?

- Breastfeeding difficulties
- VTE
- Infections
- Poor wound healing
- Long term neonatal and childhood consequences