Makindo Medical Notes

Related Subjects: Type 1 DM |Type 2 DM |Diabetes in Pregnancy |HbA1c |Diabetic Ketoacidosis (DKA) Adults |Hyperglycaemic Hyperosmolar State (HHS) |Diabetic Nephropathy |Diabetic Retinopathy |Diabetic Neuropathy |Diabetic Amyotrophy |Maturity Onset Diabetes of the Young (MODY)

1 in 20 women who give birth in the UK each year either have diabetes before theyget pregnant or develop diabetes during their pregnancy (known as gestational diabetes).

About

• Care will be by hospital doctors, midwives, specialist diabetes nurses and dietitians, as well as your GP

Types of Diabetes in Pregnancy

• Pre-existing Diabetes:
  • Type 1 Diabetes: Insulin-dependent diabetes usually diagnosed in childhood or young adulthood.
  • Type 2 Diabetes: Insulin resistance and relative insulin deficiency, often associated with obesity.
• Gestational Diabetes:
  • Diabetes diagnosed during pregnancy that was not clearly overt diabetes prior to gestation.
  • Typically diagnosed in the second or third trimester.
  • Risks
    • Age > 25, Family hx, Increased weight, Non Caucasian
    • HIV positive, Previous Gestational DM, Previous large baby (weighing > 4.5 kg)
    • Overweight (BMI > 30 kg/m2), Parent, brother or sister with diabetes
    • Family origin means you have a higher risk of developing diabetes.

Risks Associated with Diabetes in Pregnancy

• For the Mother:
  • Increased risk of preeclampsia and hypertension.
  • Higher likelihood of caesarean delivery.
  • Increased risk of developing Type 2 diabetes post-pregnancy.
  • Less awareness of hypoglycaemia
  • Miscarriage
  • Pre-term labour
  • Pre-eclampsia
  • Worsened Retinopathy
  • Worsened Nephropathy
• For the Baby:
  • Macrosomia (large birth weight) leading to delivery complications.
  • Neonatal hypoglycemia (low blood sugar) after birth.
  • Increased risk of congenital anomalies.
  • Higher risk of developing obesity and Type 2 diabetes later in life.
  • Congenital malformations
  • Macrosomia

Management Strategies for Diabetes in Pregnancy

• Preconception Care:
  • Achieve optimal blood glucose control before conception.
  • Review and adjust medications that are safe for pregnancy.
  • Take folic acid 5 mg/d until 12 weeks to reduce the risk of neural tube defects./li>
  • Discuss risks. Control/reduce weight, Optimise CBG/HbA1c. Offer folic acid 5mg/d until 12 weeks.
• Monitoring and Control:
  • Frequent monitoring of blood glucose levels.
  • Adjust insulin therapy as needed to maintain target glucose levels.
  • Regular monitoring of HbA1c to assess long-term glucose control.
  • Screen for GDM with OGTT if risks factors at booking
  • Free Eye Screening and check for renal disease
• Diet and Exercise:
  • Follow a balanced diet with appropriate carbohydrate intake.
  • Engage in regular, moderate exercise as recommended by healthcare providers.
• Medical Supervision:
  • Regular prenatal visits with an obstetrician experienced in high-risk pregnancies.
  • Consultation with a diabetes specialist or endocrinologist.
  • Ultrasound and fetal monitoring to assess the baby's growth and development.
• Medication Adjustments:
  • Use of insulin as needed to maintain blood glucose levels.
  • Avoidance of oral hypoglycaemic agents not recommended during pregnancy.

If you have type 1 diabetes

• Should be offered a continuous glucose monitor to test your blood glucose. This attaches to abdomen. Checks CBG through day.
• Alternative is a flash glucose monitor. This attaches to your arm, and monitors CBG. You have to scan the device to see what your current CBG

If you do not have type 1 diabetes

• you may still be offered continuous glucose monitoring if control is not good.
• If medications changed to try to lower your blood glucose level, you should test more often.

Targets

• Aim for 5-7 mmol/litre before breakfast ('fasting' level)
• Aim for 4-7 mmol/litre before meals at other times of the day
• Test Blood ketone levels if CBG elevated

Postpartum Considerations

• For the Mother:
  • Monitor blood glucose levels closely after delivery.
  • Adjust insulin and other medications postpartum.
  • Screen for Type 2 diabetes postpartum, especially in cases of gestational diabetes.
  • Post partum: 6wks postpartum, do a fasting glucose. Half develop DM
• For the Baby:
  • Monitor for neonatal hypoglycemia and other complications.
  • Regular pediatric check-ups to monitor growth and development.
• Breastfeeding:
  • Encouraged for mothers with diabetes as it can help regulate blood sugar levels.
  • May require adjustments in insulin dosage and monitoring of blood glucose levels.

Summary

Managing diabetes during pregnancy involves careful monitoring, lifestyle adjustments, and medical supervision to ensure the health and well-being of both the mother and the baby. Preconception care, maintaining optimal blood glucose levels, and regular prenatal visits are crucial for minimizing risks and achieving a successful pregnancy outcome. Postpartum care is also essential to manage the mother's and baby's health after delivery.