DM Flashcards by Ahmed Farag

Q

A

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Q

Modified White Classification of DM in Pregnancy

A

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Q

Modified White Classification of DM in Pregnancy

A1 & A2

A

A1: → FBS < 105 mg/d| & PPS < 120 mg/di.
A2: → FBS > 105 mg/dl & PPS > 120 mg/dl.

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Q

RF for GDM

A

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Q

Effects of Pregnancy on DM

A

Pregnancy is Diabetogenic
Change in Insulin Requirments
Increased Incidence of DM Complications
Aggravation of Retinopathy & Nephropathy

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Q

Effects of DM on Pregnancy

A

Maternal & Fetal & Neonatal

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Q

Maternal Effects of DM on Pregnancy

A

During Pregnancy
During labor
During Puerperium
Late Complications

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Q

Maternal Effects of DM on Pregnancy

Abortion

A

Due to Ag-Ab reaction associating DM or chromosomal abnormalities.

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Q

Maternal Effects of DM on Pregnancy

Preterm Labor

A

3-4 times higher in diabetics (MgSO4 is the tocolytic of choice).

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Q

Maternal Effects of DM on Pregnancy

Polyhydraminos

A

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Q

Maternal Effects of DM on Pregnancy

HTN

A

Due to vasculopathy or nephropathy.

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Q

Maternal Effects of DM on Pregnancy

Infection

A

UTI, vulvovaginitis (monilia) or chorioamnionitis (after ROM).

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Q

Maternal Effects of DM on Pregnancy

During Pregnancy

A

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Q

Maternal Effects of DM on Pregnancy

During Labor

A

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Q

Maternal Effects of DM on Pregnancy

During puerperium

A

PPH & puerperal sepsis.
Abnormal lactation: Due to changes in glucose level.

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Q

Maternal Effects of DM on Pregnancy

Late Complications

A

50% of cases è GDM will develop overt DM later on.

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Q

Neonatal Effects of DM on Pregnancy

A

Respiratory distress syndrome (RDS)
Hypertrophic cardiomyopathy
Hypoglycemia
Hypocalcemia & hypomagnesemia
Hyperbilirubinemia
Polycythemia
Poor Feeding
Birth Trauma
Late Complications

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Q

Neonatal Effects of DM on Pregnancy

RDS

A

Due to delayed lung maturity (because hyperinsulinemia inhibits secretion of pulmonary surfactant).

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Q

Neonatal Effects of DM on Pregnancy

Hypoglycemia

A

Blood glucose level < 40 mg/d| (due to hyperinsulinemia)

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Q

Neonatal Effects of DM on Pregnancy

Hyperbilirubenemia

A

Due to delay in liver maturation.

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Q

Neonatal Effects of DM on Pregnancy

Polycythemia

A

Hct value > 65% (due to chronic intrauterine hypoxia → T T erythropoietin production).

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Q

Neonatal Effects of DM on Pregnancy

Poor Feeding

A

Due to prematurity, RDS or congenital anomalies

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Q

Neonatal Effects of DM on Pregnancy

Late Complications

A

Increased risk of development of type I DM later in life (1-3% if mother only is diseased & 6% if father is diseased also

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Q

Fetal Effects of DM on Pregnancy

A

Congenital Anomalies
Macrosomia
IUGR
IUFD

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Fetal Effects of **DM** on **Pregnancy** - Congenital Anomalies

Most Common Congenital Anomalies in pregnancy with DM

Specially VSD

Most Specific Congenital Anomalies in Pregnancy in DM

Sacral agenesis (caudal regression or caudal dysplasia)

Fetal Effects of **DM** on **Pregnancy** - Macrosomia

Dx of **DM in Preegnancy** - Hx

Dx of **DM in Preegnancy** - Ex

Signs of complications (maternal or fetal).

Dx of **DM in Preegnancy** - Investigations

- Test for glucosuria - Oral glucose tolerance tests (OGTTs) - Glycosylated HbA1 (HbA1c) - Investigations to detect complications

Investigations for DM in pregnancy

...

Investigations for DM in pregnancy - Glucosuria

Done in each ANC visit & if +ve → blood investigations.

Investigations for DM in pregnancy - OGTT

- 50gm 1-hour OGTT - 100 gm 3-hours OGTT

Best Screening Test in DM with Pregnancy

50gm 1-hour OGTT

50gm 1-hour OGTT

The gold standard for diagnosis of GDM

100 gm 3-hours OGTT

100 gm 3-hours OGTT

Investigations for DM in pregnancy - HbA1c

Managment of **DM in Pregnancy** - Pre-Conceptional Care

Pre-Conceptional Care for **DM in Pregnancy**

ANC for **DM in Pregnancy**

ANC for **DM in Pregnancy** - Frequency of Visits

Glycemic Control for **DM in Pregnancy**

- Dietary recommendation - Insulin therapy

Glycemic Control for **DM in Pregnancy** - Dietary Recommendations

Glycemic Control for **DM in Pregnancy** - Insulin Therapy

The standard treatment for DM è pregnancy.

Insulin Therapy for **DM in Pregnancy**

Insulin Therapy for **DM in Pregnancy** - Goals

Keeping FBS < 105 mg/dl & 2 hours PPS < 120 mg/di.

Insulin Therapy for **DM in Pregnancy** - Insulin Preparations

Ultrashort, short, intermediate & long acting.

Insulin Therapy for **DM in Pregnancy** - Routes of adminstration

SC

Insulin Therapy for **DM in Pregnancy** - Calculation of dose

In 1st half of pregnancy: → Body weight x 0.6 units/day. In 2nd half of pregnancy: → Body weight x 0.7 units/day.

Insulin Therapy for **DM in Pregnancy** - regimens

Time of Delivery for A1 GDM

At 40 weeks (EDD)

Time of Delivery for GDM Other than A1

At 38 weeks

When to deliver at >37 weeks in **GDM**?

Prerequisites before induction of lobor in **DM in Pregnancy**

Precautions in Vaginal delivery **DM in Pregnancy**

CS in **DM in Pregnancy**

DM not indication for CS → ass. è increased incidence of CS (CS rate reaches 47%).

Indications of CS in **DM in Pregnancy**

Precautions of CS in **DM in Pregnancy**

- Glycemic control. - Prophylactic antibiotics. - Anesthesia: General anesthesia is the standard.

Neonatal Care in **DM in Pregnancy**

Perinatal Mortality in **DM in Pregnancy**

2-5% (50% of them are due to congenital anomalies).