07 Gestational Diabetes Besinque Flashcards
What complications to the FETUS does pregnancy in a women with pre-existing diabetes have?
Macrosomia/Large for gestational age (LGA) infants. Stillbirth. Neonatal death. Major congeintal malformations. Hypoglycemia, hyperbilirubinema. Jaundice
What complications to the MOTHER does pregnancy in a women with pre-existing diabetes have?
Hypoglycemia. HTN. Worsening of retinopathy, nephropathy. Increased maternal mortality
What are some pre-pregnancy couseling tips for women with diabetes?
Weight loss to BMI < 27. Keep A1c < 6.1% before conceiving. Strive for good glycemic control before/during pregnancy. Begin folic acid from PRE-conception to at least 12 weeks (5mg/day). Eye exam and nephropathy assessment pre-conception
Patients with DM often have other co-morbidities, what medications should be discontinued before pregnancy?
Statins, ACE-I/ARBs. Some OHGA. Convert to insulins that have safety record with pregnancy (Regular human, aspart, lispro, NPH)
What is a concern with women using insulin in early pregnancy?
Hypoglycemia. Counsel about warning signs. Provide glucose tablets
What are the insulin requiremens like during pregnancy?
Early (first trimester) insulin requirements decrease. After 12th week (placental formation) insulin requirements rise and require frequent adjustments (hyperglycemia concern). During labor and delivery insulin requirements decrease (hypoglycemia)
What are the premeal, bedtime, and overnight glucose goals for women with type 1 or 2 DM?
60-99
What is the peak postprandial glucose goal for women with type 1 or 2 DM during pregnancy?
100-129
What is the goal A1c for pregnant women with DM?
6%
What are the insulin requirements for women with DM who are pregnant?
Basal and prandial insulin with intensified insulin regimens (multiple dose regimens). Women using detemir or glargine can be transitioned to NPH insulin twice or three times daily. Match prandial insulin doses to carbohydrate intake, pre-meal blood glucose, and activity level. Rapid-acting insulin analogs such as lispro or aspart may produce better postprandial control with less hypoglycemia compared with the use of pre-meal regular insulin
What is the definition of gestational diabetes mellitus (GDM)?
Carbohydrate intolerance first recognized DURING pregnancy
What are the two different classifications of DM occurring during pregnancy?
Overt diabetes. Gestational diabetes
What is Overt Diabetes?
Diagnosis when a women meets any of the criteria at the 1st prenatal visit: 1) Fasting plasma glucose >126. 2) A1c > 6.5. 3) Random plasma glucose > 200 that is subsequently confirmed by elevated fasting plasma glucose or A1c, as noted above
What is Gestational Diabetes?
Diagnosis can be made when a women meets either criteria: 1) FPG > 92 but < 126 at any gestational age (FPG > 126 is overt diabetes). 2) At 24-28 weeks of gestation: 75 gram two hour OGTT with at least one abnormal result (one hour > 180 or two hour > 153)
What is the prognosis like for women with GDM?
True GDM resolves after delivery. Women with GDM may be at higher risk for DM later in life. Offspring may be more likely to develop DM
What have studies on gestational diabetes shown?
Recent studies have demonstrated significant benefits from treatment of GDM (infant or mother). Treatment is considered essential
What are some risk factors for GDM?
FHx of DM. Pre-pregnancy weight >110% IDW or BMI >30. Age > 25. Previous baby > 9lbs. Ethnicity. Previous unexplained perinatal loss of child. Mothers weight at birth was >9lbs or < 6lbs. Glycosuria at first prenatal visit. Polycystic ovary syndrome. Current use of glucocorticoids. Essential HTN or pregnancy-related HTN. Increased weight gain during pregnancy
How does glucose tolerance work in a normal pregnant person?
There is insulin sensitivity (1st trimester) followed by insulin resistance (2nd and 3rd trimester). Normal women are able to increase insulin output to counter the increased insulin resistance
How does glucose intolerance occur in GDM?
GDM is thought to develop when insulin secretion does not increase enough to counteract the decrease in sensitivity
During pregnancy, what do the hormones cause?
Lower glucose levels. Increased fat deposition. Delayed gastric emptying. Increased appetite. This leads to an increased insulin production and secretion and insulin resistance at peripheral sites