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