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Clinicals

During Pregnancy


A 35 Year Old female in her second pregnancy presents for booking at 8 weeks of gestation. 

She was diagnosed with type 2 diabetes around 3 years ago, which is currently well controlled on GLIPIZIDE ALONE. 

Her first pregnancy was 6 years ago which was uncomplicated. 

Her current HbA1c 6.7% .An ECG and urine albumin :Creatinine ratio was normal. 

On Examinations:

1:No retinopathy 
2:No evidence of neuropathy

BMI : 24kg/m2
Acanthosis Nigricans Noted 

Heart, Lung and abdomen :No abnormalities 

Perform relevant investigations

During Pregnancy


Select relevant management options

During Pregnancy


  • INSULIN
  • Statins
  • Aspirin
  • ACE inhibitors

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During Pregnancy


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During Pregnancy


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Explaination

During Pregnancy


Here, This lady presented with pregestational diabetes mellitus. 

Unfortunately, She has not received a preconception evaluations, thus it is of paramount importance to optimize her Glycemic status and medications, screen her for Co-Morbdities and come up with clear plans of management. 

We can see that her HbA1C levels indicates the excellent Glycemic control For last few months. This is a reassure finding, as hyperglycemia during the period Of organogenesis (< 9 weeks of gestation) is associated with significant incidence of congenital abnormalites. 

Dear Medical warriors, Please do note that she's on GLIPIZIDE, which is a category C drug in pregnancy ,This should be changed as soon as possible. 

Further physical examination findings reveals no evidence of microvascular OR macrovascular complications of diabetes. This supported by normal urine albumin :creatinine ratio. 

Lipid profile is important, as these patients are at risk of coexisting Dyslipidemia and cardiovascular disease. Here we could see elevated levels of LDL and Triglycerides. 

An Echocardiogram is not indicated if screening ECG is normal and physical examination shows no signs of cardiac disease and hypertension. 

In addition, TSH assay is indicated in only patients with type 1 diabetes mellitus OR in those with Chronic kidney failure. 

Even note that GFR estimates are inaccurate during pregnancy as GFR temporarily increases early stages. 

The first step in management is to stop GLIPIZIDE and start her on insulin. 

Even though she's Dyslipidemic ,Statins are contraindicated in pregnancy. Dietary control and exercise should be attempted first. 

There exist the evidence that ASPIRIN THERAPY reduces the risk of Preeclampsia and Intrauterine growth restriction ,It is probably best limited to high risk Patients i.e. in cases of obstetric History of these conditions. 

ACE inhibitors are contraindicated in pregnancy.