Diabetes in Pregnancy + Case

Intro

Types

Effects of Diabetes to the foetus

Effect on the mother

Also complications due to increased operative delivery rate

Risk factors

Pre existing Diabetes

Screening for GDM

Examination

Investigations

Management

So 3 outcomes after pregnancy and approach to diabetic treatment?

Case management

First metformin then insulin!

Insulin/dextrose drip started and adjusted according to blood sugar level

Discussion

History

Have to ask about insulin and compliance ⇒ from where taking? Storage? Know how to use? Where used? Dosages and making? Can she afford? Who gives insulin? Does she misses a dose?

Compliance? Does she know about hypoglycaemic symptoms and what to do? Has hypoglycemic symptoms ever occurred?

Refer to diabetes in medicine for this and types of insulin etc etc etc

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Definition of GDM vs PIH. PIH is only pregnacy causing hypertesnion, so only if hypertension develops at 20 weeks of pregnancy...but GDM is diabetis detected at an time during pregnacy so 20-30% can be diabateis that was pre existsing so will be detected 6 weeks after pregancy via HBa1c or FBS

Still birth particular in 3rd semester in diabetes in pregancy is 3 times higher than the normal population

Pre eclampsia is increased 3 fold in women with diabetes

Low dose aspirin from 12 weeks gestation is used to reduce the risk of pre eclampsia

Diabetic retinotpathy is a dangerous sign and can be worsened during pregancy.

On insulin must walways ask about everything about insulin and hypoglycemic awareness

During second half of pregnancy the dosages of insulin and metformin has to be increased because of increased insulin resistance

A plan for pregnancy should be set out in early pregnancy and should include renal and retinal screening fetal surveillance and a plan for delivery

If ante Natal corticosteroids are indicated additional insulin therapy is required to maintain normal glycemia , often requiring inpatient admission

Cesarion section rate amongst diabetic women is as high as 50% because of the development of microsomia, preeclampsia and the increased rate of failed induction (low threshold)

Women should be informed of the increased risk of hypoglycemia in the post natal period.

Women from particular ethnic groups ever higher risk

Women who develop GDM are at a higher risk of type 2 diabetes in later life

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