Diabetes in Pregnancy Flashcards

Flashcards on Diabetes in Pregnancy

Diabetogenic State (in pregnancy)

Pregnancy is considered a 'diabetogenic state' due to hormonal changes, primarily the production of Human Placental Lactogen (HL) and Cortisol by the placenta, which are insulin antagonists. This creates insulin resistance, typically peaking at 28-32 weeks of gestation.

Human Placental Lactogen (HL) & Cortisol

Hormones produced by the placenta during pregnancy that act as insulin antagonists, contributing to insulin resistance.

Gestational Diabetes Mellitus (GDM)

GDM develops when the pancreas cannot overcome the effects of hormones like Human Placental Lactogen and Cortisol during pregnancy, leading to glucose intolerance.

Glucose transfer in pregnancy

Glucose crosses the placenta by facilitated diffusion, and fetal blood glucose levels closely follow maternal levels.

Congenital Abnormalities (related to uncontrolled diabetes during pregnancy)

Uncontrolled diabetes before and during pregnancy can lead to congenital abnormalities in the fetus, such as endocardial cushion defects and neural tube defects.

Maternal risks (related to uncontrolled diabetes during pregnancy)

Uncontrolled diabetes during pregnancy can worsen existing maternal conditions like retinopathy, nephropathy, neuropathy, and heart disease. It also increases the risk of preterm labor, hypertension, and preeclampsia.

Macrosomic baby

A baby significantly larger than average, often associated with gestational diabetes.

Pre-conception care for diabetic women

Includes optimization of glycemic control (HbA1c < 6.5%), high-dose folic acid (5mg daily), review and discontinuation of teratogenic medications and optimization of complications.

Folic acid dosage in pre-conception care

High dose folic acid 5 mg daily to reduce risk of NTD.

Diabetes in the first trimester

Involves managing pre-existing diabetes (often unplanned) and addressing newly detected hyperglycemia or glucose intolerance.

Aspirin use in diabetic pregnancy

Low dose of aspirin (75 - 150mg daily) to prevent pre-eclampsia from 12 weeks until term

Overt diabetes in pregnancy

Diagnosis is made when blood glucose level is high during the first trimester, confirmed with a second test (FPG/RPG/OGTT).

Overt DM diagnosis criteria

FPG ≥7.0 mmol/L or RPG ≥11.1 mmol/L

Gestational Diabetes Mellitus (GDM)

Glucose intolerance of variable degree with onset or first recognition during pregnancy.

Risk factors for GDM

Previous gestational diabetes, previous macrosomia baby weighing 4 kg or above, BMI above 27 kg/m2, Family history of diabetes, Maternal age (>35 years old), Bad obstetrics history, Glycosuria > 2+ on 2 occasions, Current obstetrics problems

OGTT

Oral Glucose Tolerance Test.

Diagnosis of GDM

Diagnosed in the presence of any one of these results during OGTT: FPG ≥ 5.1 mmol/L, or 2-hours post ≥ 7.8 mmol/L

Screening for GDM

Women at risk to develop GDM at booking or as early as possible; Women age ≥ 25 with no other risk factor: 24 - 28 weeks of gestation

Antenatal Management of Diabetes in Pregnancy

Includes Medical Nutritional Therapy, Glycaemic Control (monitoring and medications), Assessment of Complications, Fetal Surveillance, and Timing & Mode of delivery.

Medical Nutritional Therapy (MNT) in diabetic pregnancy

Individualized meal plan, focuses on a carbohydrate (CHO)-controlled meal plan and Appropriate gestational weight gain (GWG)

Glycaemic control monitoring

Blood Sugar Profile (BSP) / Self monitoring blood glucose (SMBG)

Target glucose levels in pregnancy

Fasting/Pre-prandial : ≤5.3 mmol/L, 2-hours post-prandial : ≤ 6.7 mmol/L

Oral Diabetic Agent (ODA) in Pregnancy

Metformin should be continued in women who are already on the treatment before pregnancy or ODA should be offered when blood glucose targets are not met by modification in diet and exercise within 1-2 weeks

When to initiate Insulin

Blood glucose target does not met after diet and metformin, Metformin is contraindicated or unacceptable, FBG ≥ 7.0 mmol/L at diagnosis (with or without metformin)

Fetal Surveillance in Diabetic Pregnancy

Serial ultrasound especially in pre-existing diabetes.includes early scan and detailed structural anomaly scan

Timing of delivery in pre-existing diabetes

Between 37+0 to 38+6 weeks if without complications or Before 37 +0 weeks with maternal or foetal complications

Intrapartum Glycaemic control

Monitor capillary blood glucose (CBG): maintain : 4.0 - 7.0mmol/H

Postpartum management of diabetic pregnancy

Post partum glucose monitoring, metformin therapy, breastfeeding, contraception and lifestyle interventions

Post partum use of metformin

Postpartum metformin therapy significantly prevents newly-diagnosed diabetes in women with history of GDM compared with placebo (risk reduction=50.4%).