Pharmacology of Obstetrics
Diabetes in pregnancy (pre-gestational or GDM) increases risks of congenital anomalies, macrosomia, and stillbirth. Tight glucose control is critical.
Types & Pathophysiology
Pregnancy → insulin resistance (hPL, progesterone)
GDM: beta-cell failure → hyperglycemia → fetal hyperinsulinemia
Fetal Risks
| Risk | Mechanism |
|---|---|
| Malformations | 1st trimester hyperglycemia |
| Macrosomia | Fetal hyperinsulinemia |
| Neonatal hypoglycemia | Hyperinsulinemia |
| Stillbirth | Placental insufficiency |
Screening
- 24–28 weeks: 75g OGTT
- Early screening if high-risk
Management
Goals
- Fasting <95 mg/dL
- 1h PP <140, 2h <120
Treatment
- Diet + exercise
- Insulin (gold standard)
- Metformin/glyburide (selected cases)
Delivery & Postpartum
- Delivery ~38 weeks (pre-gestational)
- IV insulin + glucose in labor
- Postpartum OGTT at 6–12 weeks
Key Takeaways
- GDM → 50% risk of T2DM later
- Insulin does not cross placenta
- Target: fasting <95, 2h PP <120
- Screen all at 24–28w
- Macrosomia → cesarean if EFW >4500g
Conclusion
Diabetes in pregnancy is manageable with tight control. Every glucose reading counts.
Diabetes in pregnancy is a marathon — control wins.