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Questions and Answers
What are the two types of congenital defects that have a threefold excess in diabetic pregnancies?
Cardiac and neural tube defects.
How does poorly controlled diabetes affect fetal growth patterns during pregnancy?
It typically leads to accelerated growth patterns, especially in the late second and third trimesters.
By how much is the risk of preeclampsia increased in women with diabetes?
The risk is increased threefold.
What preventive measure should all women with diabetes be offered to reduce the risk of preeclampsia?
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List two maternal complications that can arise in pregnancies complicated by diabetes.
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What is a major concern regarding women with diabetic retinopathy during pregnancy?
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What is the recommended frequency of blood glucose monitoring for women with diabetes during pregnancy?
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What team members should be involved in the management of a pregnant woman with diabetes?
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What are the potential complications of gestational diabetes for the mother and fetus?
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What is the target premeal glucose level for women with diabetes aiming for pregnancy?
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What is the recommended HbA1c level for women with diabetes prior to conception?
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Why is it important to optimize glycaemic control before pregnancy in diabetic women?
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What innovative technology can improve glycaemic control in pregnancy for diabetic patients?
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In women with nephropathy, what is the likelihood of complications arising during pregnancy?
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What role does multidisciplinary team review play for women with diabetic complications before pregnancy?
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What is one psychological aspect that diabetes counseling should address prior to pregnancy?
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Study Notes
Gestational Diabetes
- A primigravida at 29 weeks pregnant was diagnosed with gestational diabetes based on a 2-hour oral glucose tolerance test (OGTT).
- Her fasting plasma glucose was 7.3 mmol/L.
- Gestational diabetes (GDM) develops during pregnancy.
- Prepregnancy counseling aims to optimize glycemic control before pregnancy and educate diabetic women about the implications of pregnancy.
Prepregnancy Care and Management
- Aim for HbA1c of 85 mmol/mol to reduce fetal loss risk to approximately 30%.
- Prepregnancy care is associated with lower rates of congenital malformations.
- Intensify diabetes therapy and encourage contraception until good glucose control is achieved.
- Target pre-meal glucose levels of 4–7 mmol/l.
- Newer insulin delivery systems, such as continuous subcutaneous insulin infusion pumps and glucose sensors, can help improve glycemic control.
- Diabetic vascular complications are common in women of reproductive age.
- Women with significant retinopathy, nephropathy, or neuropathy require a multidisciplinary team review before pregnancy.
- Create a medication adjustment plan and counsel about additional potential complications associated with diabetic microvascular disease.
- Women with nephropathy have a significantly increased risk of complications during pregnancy that often necessitate preterm delivery.
- Retinopathy can progress during pregnancy and the postpartum period.
Maternal and Fetal Complications
- Congenital abnormalities are 2-4 times more common in diabetic pregnancies, with a threefold increase in cardiac and neural tube defects.
- Accelerated growth patterns are typical in the late second and third trimesters and are associated with poorly controlled diabetes in the majority of cases.
- Maternal morbidity in diabetic pregnancies is linked to the severity of diabetic-related vascular disease.
- Preeclampsia risk is tripled in women with diabetes, especially those with underlying microvascular disease.
- All women with diabetes should be offered low-dose aspirin from 12 weeks’ gestation to reduce preeclampsia risk.
- Women with diabetic retinopathy require careful surveillance, including retinal screening at booking, 16–20 weeks, and 28 weeks of gestation.
Effects of Diabetes on Pregnancy
- Increased risk of miscarriage
- Increased risk of congenital malformations
- Increased risk of macrosomia, contributing to traumatic births and shoulder dystocia
- Increased risk of preeclampsia, especially in women with underlying microvascular disease
- Increased risk of stillbirth
- Increased risk of infection
- Increased operative delivery rate
Effects of Pregnancy on Diabetes
- Nausea and vomiting, particularly in early pregnancy
- Increased need for tight glucose control
- Increased insulin dose requirements in the second half of pregnancy
- Increased risk of severe hypoglycemia
- Risk of deterioration of pre-existing retinopathy
- Risk of deterioration of established nephropathy
Diabetes Management in Pregnancy
- Women with diabetes should be managed by a multidisciplinary team including a diabetic specialist midwives and nurses, a dietician, an obstetrician, and a physician.
- The primary goal of the team is to support the woman and her family during pregnancy and optimize glycemic control safely.
- Blood glucose monitoring is encouraged 7 times a day (before and 1 hour after meals).
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Description
This quiz covers essential information about gestational diabetes, including diagnosis, management, and the importance of pre-pregnancy care. It discusses the implications of glycemic control on both maternal and fetal health, alongside modern insulin delivery methods. Test your understanding of these critical topics related to diabetes in pregnancy.
