MCQ Obstetrics Answer 5

Elevated HbA1c at the time of conception has been shown to be associated with a marked increase in congenital malformations, and 30 to 50 % of perinatal mortality in diabetic pregnancy is due to fetal malformations.

Sacral agenesis and caudal dysplasia are 400 times more frequent in diabetic than in normal pregnancies. Other anomalies associating with diabetes during first trimester include open spina bifida, anencephaly, renal agenesis, ventricular septal defects, and great vessels transposition. Offspring of diabetic women also face specific risks during late pregnancy, mostly related to deficits in placental exchanges of oxygen and nutrients.

Delivery before 37 weeks is associated with an increased risk of RDS, while delivery after 40 weeks carries an unacceptable risk of fetal demise. Women with poorly controlled diabetes should therefore probably be delivered at 37-38 weeks, after testing for lung maturity.

Category: Obstetrics MCQs