Diabetes in pregnancy
About
When a woman has a baby inside her, she tends to have lowered glucose tolerance. This means that people are more diabetic in pregnancy than they are outside of it.
So a woman with diabetes before she got pregnant is more likely to suffer from complications, and a women with some impaired glucose function will get bad enough to be classified as “diabetic” whilst she is pregnancy; this is gestational diabetes. 50% of women who get gestational diabetes end up developing diabetes within the next 10 years.
Epidemiology
- Pre-existing diabetes – around 0.5% of pregnancies
- Gestational diabetes – around 2% of pregnancies
Clinical features
Baby
- Big babies - more likely to be a big baby, which can cause problems.
- Weird babies - Higher rate of congenital abnormalities in the child.
- Early babies - Preterm labour is more common.
- Suffocating babies - Foetal lung maturity is less advanced, making RDS more common.
- Ill babies - Foetal distress, and the related sudden foetal death, are more common, especially if the glucose level is poorly controlled.
Mum
- Increased insulin use.
- Higher chances of getting ketoacidosis, and other diabetes side effects, such as retinopathy.
- UTI is more common.
- So is pre-eclampsia.
These symptoms are usually seen in those with pre-existing diabetes. Gestational diabetics usually have no symptoms, although any of the above complications can affect them.
Investigations
Glucose tolerance test at 26 weeks.
Management
Firstly, the ones more at risk from problems are those with pre-existing diabetes. Be worried about them.
The main thing that is done is loads of extra assessment. They get seen more often than normal pregnant women, and everything is measured more often. The key thing is maintaining glycaemic control.
In the patient with pre-existing diabetes, labour is induced earlier.