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9 Cards in this Set
- Front
- Back
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What are the potential maternal complications of diabetes in pregnancy?
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1. Pre-eclampsia (18% vs 6%)
2. Birth trauma (large baby) 3. CS |
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What are the potential foetal complications of diabetes in pregnancy?
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1. Polyhydramnios
2. Macrosomia (>90th centile) (63% vs 10%) - shoulder dystocia (requires McRoberts manoeuvre) 3. Increased perinatal mortality (esp. late FDIU) 4. Neonatal hypoglycaemia 5. Neonatal hyperbilirubinaemia 6. Increased risk of miscarriage 7. Congenital malformations (good control reduces the risk) |
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Why is pregnancy diabetagenic?
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1. Human placental lactogen (HPL)
2. Progesterone |
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What is the risk of a woman with GDM going onto develop T2DM?
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50% risk of developing within 20yrs
*Greater if other risk factors such as obesity and lower if ideal body weight *note: 10% of GD woman will go not to develop T1DM (most likely as they have a latent T1DM (antibody mediated)) |
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What are the risk factors for developing GDM?
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1. Obesity
2. FHx 3. Previous baby > 4.1kg 4. Glycosuria at first visit 5. Previous GDM (50% will recur) 6. > 25yrs 7. PCOS 8. Steroid use |
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How do you screen for GMD?
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1. GCT at 24-28 weeks (50g glucose with NO fasting... >8 = OGTT)
2. OGTT to confirm diagnosis (use 1st line in high risk woman) * if |
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What is the peri-partum Mx of GDM mothers?
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If diet controlled with good control
1. No Mx required. Consider inducing at EDD If on Insulin 1. CTG weekly from 28 weeks 2. Estimate Foetal weight (CS indicated if > 4.5kg) 3. Induce at 39-40 wks |
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What is the post natal Mx of GDM?
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1. OGTT at 8 weeks post partum
2. Lifestyle modifications (exercise, diet etc) 3. Monitor for the development of T2DM (GP follow up) |
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What is the Mx of a woman with pre-existing diabetes?
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1. Pre-pregnancy counselling (switch to insulin from oral hypoglycaemics)
2. Assess eyes and renal function, thyroid 3. Multidisciplinary approach (ons, endo, diabetes edu, dietician) 4. early US at 28, 34, 36 weeks 5. Regular MSU (asymptomatic bacteruria is common in pregnancy) |
