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Gestational DM


When do you screen with 1 hour glucose At 24-28 weeks in patients >25 or family history of DM or Ethnic risk (AA, Hispanic, Native American, Asian)
Risk factors for GDM >25 years, prior GDM/family hx, prior big baby/still birth, BMI >/=27, chronic HTN, glycosuria
What is the biggest complication of GDM Big babies that don’t want to come out (macrosomia/ shoulder dystocia)
What are the birth traumas associated with macrosomia Brachial plexus injury, clavicular injury, facial nerve injury
Risk factors for fetal growth restriction CVD (hypertension), smoking, fetal abnormalities, multifetal gestation, abnormal placentation, poor maternal wt gain or nutrition
In second half of PG, increased concentrations of __ combine to produce modest maternal insulin resistance, which is countered by postprandial hyperinsulinemia Human placental lactogen, free and total cortisol, and prolactin
What is the most common medical complication of pregnancy Diabetes mellitus
Preexisting diabetes mellitus affects approximately __ per 1000 pregnancies 1-3
Defined as any degree of glucose intolerance with first recognition during pregnancy Gestational diabetes
GDM complicates __% of pregnancies 4
Women with GDM have an approximately __% risk of developing type 2 diabetes over the next 10 years 50
hormone mainly responsible for insulin resistance and lipolysis = Human placental lactogen (similar structure to growth hormone: reduces insulin affinity to insulin receptors)
HbA1C can predict the risk for __ when measured in the first trimester Malformation
Higher maternal glucose => higher fetal glucose => higher levels of insulin => fetal: Macrosomia, central fat deposition, enlargement of internal organs such as the heart
What are risk factors for developing GDM Obesity, prior hx of GDM, heavy glycosuria, unexplained stillbirth, prior infant with major malformation, family hx of DM in first degree relative
When should at risk pregnant women be screened for GDM As soon as feasible and again between 24 and 28 weeks
Which women can be omitted for GDM screening Age <25, normal body wt, no family hx, no hx of abnormal glucose metabolism/poor OB outcome, and not a member of an ethnic or racial group at high risk
What are the ethnic or racial groups with a high prevalence of diabetes Hispanic Americans, Native Americans, Asian Americans, African Americans, Pacific Islanders
What is the mainstay of treatment in the pregnant women with pregestational diabetes Rigorous control of blood glucose
What is an optimal fasting glucose in pregnancy 70-95
What is an optimal 1-hr postprandial glucose value during pregnancy Less than 140
What is an optimal 2-hr postprandial glucose value during pregnancy Less than 120
Complications of GDM macrosomia, jaundice, hyaline memrane dz, birth defects, hypoglycemia, low Ca, adult overweight
GDM tx Diet & exercise, insulin/NPH, metformin, glyburide (sulfonylurea)
Diet mgmt for GDM 24 (overweight pt), 30 (normal), and 40 (underweight) kcal/kg/day. 20% protein, 40% fat, 40% carb
Insulin dose First trimester: 0.8U / kg body wt. 2nd: 1.0 U/kg. 3rd: 1.2 U/kg. 2/3 of total daily dose (NPH & regular) before breakfast. 1/6 regular insulin before dinner, 1/6 NPH at bedtime.
GTT is diagnostic for gestational DM with these values: >130 on 1st screen (50gm, check at 1 hr). Confirmatory screen (100gm): >180 at 1 hr, >155 at 2 hr, >140 at 3 hr
Created by: Abarnard