🤰 Diabetes in Pregnancy – Blood sugars often fall early in pregnancy but rise in the 2nd/3rd trimester due to placental hormones 🌸. Good glycaemic control reduces maternal and fetal complications 🩸.

📖 International Definitions

Normal fasting sugar < 6.1 mmol/L (110 mg/dL); 2 hr < 7.8 mmol/L (140 mg/dL).
Diabetes: Fasting ≥ 7.0 mmol/L (126 mg/dL).
Impaired glucose tolerance: OGTT 2 hr glucose 7.8–11 mmol/L (140–199 mg/dL).
Diabetes: Random glucose ≥ 11.1 mmol/L (200 mg/dL) + symptoms (repeat if asymptomatic).

🧬 About

Glycosuria is common (renal threshold lowered).
Placental hormones (HPL, progesterone, cortisol) → ↑ insulin resistance in late pregnancy.
Insulin needs rise in 2nd/3rd trimester, then fall dramatically once placenta delivered.
Strict control reduces maternal + fetal complications.

✅ Diagnostic Summary

Onset during pregnancy.
Fasting glucose > 5.5 mmol/L.
OGTT 2 hr > 9.0 mmol/L.
Raised HbA1c supports diagnosis.

🛠️ Management

🍎 Diet: Specialist dietary advice.
📈 Frequent blood glucose monitoring.
💉 Insulin if levels consistently >6–7 mmol/L (oral agents avoided).
👁️ Fundoscopy every 4–6 weeks (risk of retinopathy progression).
👶 Ultrasound to monitor fetal growth and amniotic fluid.
🧪 Frequent checks: urine protein, BP → detect pre-eclampsia.
👩‍⚕️ Multidisciplinary care (diabetes nurse, endocrinology, obstetrics).
In labour: IV dextrose + insulin infusion → maintain 4–6 mmol/L.
After birth: insulin requirements drop sharply → often stop insulin.

⚠️ Risks of Gestational Diabetes

Maternal: Pre-eclampsia, ↑ risk of future T2DM.
Fetal: Macrosomia (↑ risk shoulder dystocia), polyhydramnios, birth trauma (palsies, fractures).
Neonatal: Hypoglycaemia, hypocalcaemia, respiratory distress.

💡 Clinical Pearl: - Always screen women with risk factors (BMI >30, family history, previous macrosomic baby). - In UK: OGTT offered at 24–28 weeks in high-risk mothers.

📚 Case Example

👩 A 32-year-old woman (BMI 34) at 26 weeks presents with tiredness. OGTT: Fasting 6.2 mmol/L, 2 hr 9.8 mmol/L. ✅ Diagnosis: Gestational Diabetes. 🛠️ Management: Dietary advice, start insulin if sugars >6–7 mmol/L, regular growth scans. ⚠️ At delivery: increased risk of shoulder dystocia and neonatal hypoglycaemia.

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Diabetes Mellitus in Pregnancy