Diseases of the Mother in Pregnancy

Abstract

Gestational diabetes is a condition of pregnancy relating to insulin resistance that most commonly resolves following delivery. It increases risk of macrosomia and fetal death, and can be treated with insulin and diet modification. Risk factors include mothers over 25 years old, obese mothers or a family history of the condition.
Pre-eclampsia is a condition in pregnant women characterised by a blood pressure of greater than 140/90 (hypertension) and spontaneous proteinuria. Risk factors include mothers over 40, obese mothers and family history. Resolved by delivery of the fetus. Treatment includes antihypertensives.

Core

Gestational Diabetes

Gestational diabetes is a condition characterised by episodes of hyperglycaemia during pregnancy due to insulin resistance. However, gestational diabetes often resolves following birth. It is important to have a baseline for insulin resistance before pregnancy, because some women may be very likely to develop gestational diabetes if they are already resistant to insulin, or unable to produce adequate insulin.

Clinical implications of gestational diabetes can be serious and include:

Increased incidence of miscarriage.
Increased risk of congenital malformation – reduced with good glycaemic control during pregnancy.
Increased incidence of macrosomia (a larger than normal baby). Macrosomia increases risk of shoulder dystocia which is an obstetric emergency. Shoulder dystocia is when the shoulders of the baby get stuck in the birth canal. This can lead to significant fetal morbidity and mortality. There can also be a risk to the mother of post partum haemorrhage and perineal tears. Brachial plexus injury to the baby is also possible.
Increased risk of gestational hypertension and pre-eclampsia.
Increased risk of developing Type 2 Diabetes Mellitus (T2DM) after delivery.

Diagnosis is achieved through an oral glucose tolerance test (>7.8 mmol/L) or fasting glucose (5.6mmol/l). Mothers at risk of gestational diabetes are screened with an oral glucose tolerance test.

Management

Dietary modification – management like any patient recently diagnosed with T2DM (basically eating less sugar).
Dietician input
Medication – metformin and insulin can be considered if target blood sugar is not achieved.
Regular fetal monitoring – this is important to prepare for macrosomia and to check for congenital malformation.

Risk Factors

Maternal BMI over 30
Family history of diabetes of any sort
Family history of macrosomia (as these might have been cases of undiagnosed gestational diabetes)
Previous baby above 4.5kg or previous history of gestation diabetes
Previous gestational diabetes
Ethnicity with high diabetes prevalence – South Asian, Afro-Caribbean, Middle Eastern

Pre-Eclampsia

Pre-eclampsia is a potentially serious disease in the mother during pregnancy. It is defined as hypertension of 140/90 or more and proteinuria after 20 weeks gestation in a previously normotensive woman.

The cause of pre-eclampsia is caused unclear but is associated with inadequate trophoblastic invasion of the placental arterioles. As a result there is associated fetal growth restriction and placental failure so the body attempts to increase blood flow to the placenta. This is done by raising the maternal blood pressure, which causes kidney damage, resulting in proteinuria.