Obstetrics
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| 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)
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| Risk factors for GDM | >25 years, prior GDM/family hx, prior big baby/still birth, BMI >/=27, chronic HTN, glycosuria
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| What is the biggest complication of GDM | Big babies that don’t want to come out (macrosomia/ shoulder dystocia)
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| What are the birth traumas associated with macrosomia | Brachial plexus injury, clavicular injury, facial nerve injury
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| Risk factors for fetal growth restriction | CVD (hypertension), smoking, fetal abnormalities, multifetal gestation, abnormal placentation, poor maternal wt gain or nutrition
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| 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
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| What is the most common medical complication of pregnancy | Diabetes mellitus
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| Preexisting diabetes mellitus affects approximately __ per 1000 pregnancies | 1-3
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| Defined as any degree of glucose intolerance with first recognition during pregnancy | Gestational diabetes
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| GDM complicates __% of pregnancies | 4
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| Women with GDM have an approximately __% risk of developing type 2 diabetes over the next 10 years | 50
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| hormone mainly responsible for insulin resistance and lipolysis = | Human placental lactogen (similar structure to growth hormone: reduces insulin affinity to insulin receptors)
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| HbA1C can predict the risk for __ when measured in the first trimester | Malformation
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| Higher maternal glucose => higher fetal glucose => higher levels of insulin => fetal: | Macrosomia, central fat deposition, enlargement of internal organs such as the heart
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| 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
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| When should at risk pregnant women be screened for GDM | As soon as feasible and again between 24 and 28 weeks
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| 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
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| What are the ethnic or racial groups with a high prevalence of diabetes | Hispanic Americans, Native Americans, Asian Americans, African Americans, Pacific Islanders
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| What is the mainstay of treatment in the pregnant women with pregestational diabetes | Rigorous control of blood glucose
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| What is an optimal fasting glucose in pregnancy | 70-95
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| What is an optimal 1-hr postprandial glucose value during pregnancy | Less than 140
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| What is an optimal 2-hr postprandial glucose value during pregnancy | Less than 120
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| Complications of GDM | macrosomia, jaundice, hyaline memrane dz, birth defects, hypoglycemia, low Ca, adult overweight
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| GDM tx | Diet & exercise, insulin/NPH, metformin, glyburide (sulfonylurea)
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| Diet mgmt for GDM | 24 (overweight pt), 30 (normal), and 40 (underweight) kcal/kg/day. 20% protein, 40% fat, 40% carb
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| 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.
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| 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
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