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Chapter 57 - Pregestational Type 1 Diabetes Mellitus

from Section 10 - Endocrine Disorders in Pregnancy

Published online by Cambridge University Press:  23 February 2023

By
Melissa-Rosina Pasqua ,
Amira El-Messidi  and
Natasha Garfield
Edited by
Amira El-Messidi  and
Alan D. Cameron
Amira El-Messidi
Affiliation:
McGill University, Montréal
Alan D. Cameron
Affiliation:
University of Glasgow
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Summary

During your call duty, a 25-year-old primigravida with a 12-year history of type I diabetes mellitus (T1DM) at 26+1 weeks’ gestation by early sonographic dating of an unplanned pregnancy is accompanied by her husband to the obstetric emergency assessment unit at 4:00 AM for a three-hour history of nausea followed by recurrent nonbilious vomiting. Despite the lack of oral intake since her standard bedtime snack, her husband indicates the patient passed urine at least five times over the last hour, as he assisted her due to drowsiness and visual blurring.

Keywords

Type I diabetes mellitus, pregestationalDiabetic ketoacidosisInvestigationsLaboratory derangementsFetal heart tracing, cardiotocographyPregnancy physiologyClinical presentationRisk, precipitating factorsTreatment, managementPerinatal risks, complications, maternal-fetal morbidity, adverse outcomeAntepartum, intrapartum, postpartum managementObstetric deliveryReal-time continuous glucose monitoringDiabetic retinopathy, pregnancyPostpartum thyroiditis
Type
Chapter
Information
OSCEs in Obstetrics and Maternal-Fetal Medicine
An Evidence-Based Approach
 , pp. 731 - 743
Publisher: Cambridge University Press
Print publication year: 2023

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References

Suggested Readings

American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins – Obstetrics. ACOG Practice Bulletin No. 201: pregestational diabetes mellitus. Obstet Gynecol. 2018;132(6):e228–e248.Google Scholar
American Diabetes Association. 14. Management of diabetes in pregnancy: standards of medical care in diabetes – 2021. Diabetes Care. 2021;44(Suppl 1):S200–S210.Google Scholar
Alexopoulos, AS, Blair, R, Peters, AL. Management of preexisting diabetes in pregnancy: a review. JAMA. 2019;321(18):1811–1819.Google Scholar
Diabetes Canada Clinical Practice Guidelines Expert Committee, Feig, DS, Berger, H, et al. Diabetes and pregnancy. Can J Diabetes. 2018;42(Suppl 1):S255–S282. [Correction in Can J Diabetes. 2018 Jun;42(3):337]Google Scholar
Joint British Diabetes Societies for Inpatient Care (JBDS-IP). Management of glycaemic control in pregnant women with diabetes on obstetric wards and delivery units. May 2017. Available at https://abcd.care/sites/abcd.care/files/resources/JBDS_Pregnancy_201017.pdf. Accessed September 6, 2021.Google Scholar
McCance, DR, Casey, C. Type 1 diabetes in pregnancy. Endocrinol Metab Clin North Am. 2019;48(3):495–509.CrossRefGoogle ScholarPubMed
Mohan, M, Baagar, KAM, Lindow, S. Management of diabetic ketoacidosis in pregnancy. The Obstetrician and Gynaecologist 2017;19:655–662.Google Scholar
National Institute for Health and Care Excellence (NICE). Diabetes in pregnancy: management from preconception to the postnatal period; NICE guideline. February 25, 2015. Available at www.nice.org.uk/guidance/ng3. Accessed July 18, 2021.Google Scholar
Scottish Intercollegiate Guidelines Network (SIGN). Management of diabetes, a national clinical guideline. March 2010, updates November 2017. Available at www.sign.ac.uk/assets/sign116.pdf. Accessed July 18, 2021.Google Scholar
Sibai, BM, Viteri, OA. Diabetic ketoacidosis in pregnancy. Obstet Gynecol. 2014;123(1):167–178.CrossRefGoogle ScholarPubMed

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