Makindo Medical Notes

🤰 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.

📚 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.