1. Diabetes in pregnancy
Dr Than Than Yin

2. Physiological changes
Pregnancy is a state of physiological insulin resistance and relative glucose intolerance
Glucose handling is altered
Glucose tolerance decreases progressively with increasing with pregnancy
Renal tubular threshold for glucose fall in pregnancy

3. Diabetes in pregnancy
Gestational diabetes
Pre-existing diabetes
-0.4%
Pre-existing GDM
True GDM
Type 1
0.5%
Type2
3-4%

4. Complications of pregnancy in pre-existing diabetes
Maternal
Increased insulin requirements
Hypoglycemia
Infection
Ketoacidosis
Deterioration in retinopathy
Increased proteinuria and oedema
Miscarriage
Polyhydramnios
Shoulder dystocia
Pre-eclampsia (threefold to fourfold increased)
Increased caesarean section rate
Fetal
Congenital abnormalities -4%-neural tube defects, congenital heart disease
Increased neonatal morbidity
Increased perinatal mortality-3%
Macrosomia
Preterm delivery
Neonatal hyperglycemia
Polycythemia
Jaundice
Respiratory distress syndrome

5. Diagnosis of diabetes mellitus
Random blood glucose
>11.1 mmol/Lit
Fasting blood glucose
>7 mmol/Lit
2 hour plasma glucose concentration
>11.1 mmol/Lit after 75mg anhydrous glucose in an oral glucose tolerance test

6. Management
Women with diabetes planning pregnancy require pre-pregnancy counseling
Pregnant women with diabetes- seen in joint clinic with obstetricians and physicians
Multidisciplinary clinics with dieticians and nurse prationers

7. Impaired GTT
After fasting -<7.0
After 2hrs - >7.8

8. Medical Management To achieve normoglycemia
Increase the frequency of home blood glucose monitoring
Target
fasting mmol/Lit
7.8 mmol/Lit after postprandial

9. Management Women with type I diabetes Type 2 diabetes
require higher doses of insulin
Type 2 diabetes
Oral hypogylcemic agents- traditionally discontinued in pregnancy
NICE guideline states that Metformin can be used