T2 L19 Pregnancy and Diabetes Flashcards
(31 cards)
Why does diagnosing maternal hyperglycemia matter?
It affords an opportunity to prevent
-morbidity In the offspring “from the uterus to the
grave”
-an exacerbation of the obesity & Type 2 diabetes
epidemic
-future Type 2 diabetes in the mother
At ANC booking there are 2 groups. What are they?
- Women with Normal Glucose tolerance
- Women with Abnormal Glucose tolerance
- Known Diabetes or IGT
- Unknown Diabetes or IGT
What are the causes of pre-gestational hyperglycaemia?
Type 1 Diabetes
Type 2 Diabetes
- known
- unknown
Monogenic Diabetes
Impaired Glucose Tolerance (IGT)
What is “Gestational Diabetes”?
Any newly found Abnormal GTT after the 1st trimester of pregnancy ( i.e. Diabetes or IGT )
What is the WHO and NICE guidelines for gestational diabetes?
Diabetes OR Impaired Glucose Tolerance
- Fasting glucose =/ > 5.6 mmol/l
- 2 hour GTT glucose =/ > 7.8 mmol/l
What is the International Association of Diabetes & Pregnancy Study Group (IADPSG) Criteria for gestational diabetes?
75 g Glucose Tolerance test
- Fasting 5.1 mmol/l - 1 hour 10.0 mmol/l - 2 hours 8.5 mmol/l
Diagnose if 1 or more abnormal
What are the stages of pregnancy?
1st Trimester
- Organogenesis
- Carefully design the essential components
- Avoid Mistakes ( Teratogenesis)
- Construct & programme the placenta
2nd Trimester
-Further complex development & linkage
3rd Trimester
-Accelerated growth
What are the changes to maternal metabolism during early pregnancy?
Facilitated Anabolism
- Increased Insulin sensitivity
- Glucose concentration slightly lower
- Increased maternal energy stores
What are the changes to maternal metabolism during late pregnancy?
Facilitated Catabolism
- Increased Insulin resistance
- Increased transplacental passage of nutrients
This leads to rapid fetal growth
How does maternal hyperglycaemia mess with the different stages of pregnancy?
1st trimester Increased Fetal abnormalities -Fuel Mediated Teratogenesis (due to increased maternal blood glucose levels this leads to foetal malformation) Abnormal placental programming -Increased risk of Pre-eclampsia -Excessive glucose transport
3rd Trimester
Excessive fat deposition
Adverse Fetal programming ( epigenetics )
What kind of foetal malformations can maternal hyperglycaemia in the first trimester lead to?
Hydrocephalus
Meningomyelocoele (the child will require surgery and may not be able to walk and talk normally)
Central cyanosis (in congenital heart disease)
Single Ventricle & Sacral Dysgenesis
Renal agenesis
How can foetal Malformation due to maternal hyperglycaemia be prevented?
Good Diabetes Control in 1st Trimester
Folic Acid 5mg / day
How can good Diabetes Control in 1st Trimester be achieved?
Prepregnancy counselling
- Lifestyle Modification
- Intensive glucose monitoring
- Optimize Insulin Regimen
- If not on Insulin commence Insulin
What are the risk factors for unknown cases of Diabetes / IGT?
- Previous Gestational Diabetes
- Obesity (BMI >30)
- Polycystic ovarian syndrome
- Family history of type 2 diabetes
- High risk racial group (Indian subcontinent- India/Paskistan, Hispanic people)
- Older age
What problems in the 3rd trimester are due to maternal hyperglycaemia?
- Macrosomia & associated problems
- Pre-eclampsia
- Fetal or Neonatal death
What does macrosomia (in the baby)?
- Difficult Birth
- Shoulder Dystocia
- Breathing Problems
- Jaundice
- Hypoglycaemia
What is the risk of increased perinatal mortality in T1DM and T2DM?
Type 2 diabetes x 9
Type 1 Diabetes x 4
NOTE: T2DM do worse perhaps due to late diagnosis in comparison to T1D
What is the lifelong foetal sequele due to hyperglycaemia in pregnancy?
- Obesity
- Insulin resistance
- Type 2 diabetes
- Dyslipaemia
- Hypertension
- Vascular disease
What has happened to the number of women
with diabetes during pregnancy?
It has more than doubled
This is a finding that raises health concerns for both mothers-to-be and babies.
How many women are obese at their antenatal booking?
1 in 5
When is screening carried out to detect GDM (gestational diabetes mellitus)?
Universal or Targeted Screening at 26 weeks
How can any pregnancy hyperglycaemia be treated?
Good maternal glucose control
-Intensive blood glucose monitoring
Fasting + 1 hour post prandial minimum
Appropriate nutrition (the women get nutritional counselling)
Reasonable exercise (e.g. brisk walking)
Ultrasound monitoring of Foetal abdominal girth
-Monthly from 28 weeks
Maternal observation of Foetal movements
What are the targets for hyperglycaemia in pregnancy?
Fasting glucose < 5.1 mmo/l
1 hour postprandial glucose < 7 mmol/l
Fetal Abdominal girth < 70th centile
-less in Asians
How is drug treatment to achieve good maternal glucose control in pregnancy?
Prepregnancy /1st trimester hyperglycaemia
-Basal bolus Insulin regimen (long acting insulin
injection)
“Gestational” diabetes -Metformin -Basal Insulin -Basal bolus Insulin -Glibenclamide (Uncommon in UK, used more in the US)
