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  • Diabetic Pregnancy Counselling

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    Establishing good glycaemic control before conception and while continuing the pregnancy is very important to reduce complications eg miscarriage, neonatal death,still birth and congenital malformation. HbA1c aims below 6.1%.if more than 10% strongly advised to avoid pregnancy. Offer monthly up till 2nd trimester avoid unplanned pregnancy role of diet, body weight and exercise if patient's BMI >27 nausea and vomiting might cause hypoglycaemia.

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    Establishing good glycaemic control before conception and while continuing the pregnancy is very important to reduce complications eg miscarriage, neonatal death,still birth and congenital malformation. HbA1c aims below 6.1%.if more than 10% strongly advised to avoid pregnancy. Offer monthly up till 2nd trimester avoid unplanned pregnancy role of diet, body weight and exercise if patient's BMI >27 nausea and vomiting might cause hypoglycaemia.

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    2K views2 pages

    Diabetic Pregnancy Counselling

    Uploaded by

    latiffidalila
    Establishing good glycaemic control before conception and while continuing the pregnancy is very important to reduce complications eg miscarriage, neonatal death,still birth and congenital malformation. HbA1c aims below 6.1%.if more than 10% strongly advised to avoid pregnancy. Offer monthly up till 2nd trimester avoid unplanned pregnancy role of diet, body weight and exercise if patient's BMI >27 nausea and vomiting might cause hypoglycaemia.

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    OSCE station:Diabetic pregnancy counselling Diabetic lady who wants to get pregnant 1) check her understanding about diabetes

    -ask about her diabetic control. Is she taking medication? Metformin or insulin? Any other medication eg for hypertension?contraception?smoking? Alcohol? 2) Pre-conception counselling: Informed that establishing good glycaemic control before conception and while continuing the pregnancy is very important to reduce complications eg miscarriage, neonatal death,still birth and congenital malformation .( will be explained below). HbA1c aims below 6.1%.if more than 10% strongly advised to avoid pregnancy. Offer monthly up till 2nd trimester avoid unplanned pregnancy role of diet, body weight and exercise if patients BMI >27 nausea and vomiting might cause hypoglycaemia stop smoking (offer cessation clinic) and reduce alcohol you will be offered pre-conception care and advice before discontinuing contraception. Eg: folic acid 5mg every day before conception, arrange dietetic review, Eye check, kidney check stop medication : oral hypoglycaemic (except metformin),statins,ACE, A2A inhibitor.not safe for pregnancy.metformin as an adjunct to insulin preconception and during pregnancy. if hypertension, take methyldopa( discuss with doctor)

    offer ketone testing strip and advised to test for ketonuria whenever hypoglycaemic or feeling unwell. offer a meter for self monitoring glucose

    3) Complications Maternal Fetal and neonatal

    -hypoglycaemia -ketoacidosis -microvascular eg nephropathy, retinopathy, hypertension -miscarriage -c-section

    -still birth -preterm labour -big baby-shoulder dystocia -increase malformation risk -respiratory distress syndrome -hypoglycaemia ( after birth. Initially in uterus, glucose crosses placenta but not insulin. When delivered, insulin secretion increase due to increase level of glucose ( hyperinsulinaemia) result in hypoglycaemia) -polycythaemia-neonatal jaundice

    4) Antenatal Care - Self monitor glucose.aim for <7.8 mmol/L (postprandial-1 hr after meal) 3.5-5.9 mmol/L (fasting) -test blood glucose before going to bed -partners and families should be advised on how to treat hypoglycaemia -consider rapid acting insulin analogue - Regular assessment for renal and retina 5) Advised to give birth in hospital so can monitor baby and mother

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