3.1.2 Diabetes in Pregnancy Flashcards
Explain the physiology occuring in the 2nd and 3rd trimester that can affect glucose levels?
What are the medications used for pregnancy diabetes?
Glyburide
Metformin
Insulin
How does regular insulin compare to NPH insulin?
What are some of the neonatal complications associated with a baby who had a mother with DM?
Newborn infant may be delivered in a state of hyperinsulinemia - severe hypoglycemia immediately after birth
Increased rate of respiratory distress syndrome, polycythemia, organomegaly, electrolyte disturbances.
Increased rate of obesity and carbohydrates intolerance in life
What is pregestation vs gestational diabetes?
Pre - diagnosed prior to pregnancy
Gestational - diagnosed during the pregnancy
What are the fetal complications of Preexisting DM?
Spontaneous abortions
Congenital malformations
What are some medications not allowed for pregnancy diabetes?
Thiazolidinediones
DPP-4 inhibitors
GLP-1 receptor agonist
Describe the delivery schedule for a baby whose mother has pregnancy diabetes.
What are the fetal complications with GDM?
Basically overgrowth:
Hydramnios
Macrosomia
Stillbirth
Pregestational diabetes increases the risk for?
Preeclampsia, uteroplacental insufficiency, IUGR, and preterm birth
What is the concept of Gestational Diabetes Mellitus?
Carbohydrate intolerance that begins or is 1st recognized in pregnancy
Some women have previously unrecognized overt diabetes
Diabetic mother will have an increased or decreased risk for infection?
Diabetic mothers will have an increased risk for infections throughout pregnancy
Post-operative would infections - if baby is delivered by C-section
What are the effects of elevated estrogen in the first trimester?
Stimulate Beta cell hyperplasia + insulin secretion
Enhancing insulin sensitivity - episodes of maternal hypoglycemia
Describe the fetal care for babies with a mother that has pregnancy diabetes
How do HbA1c levels relate to rate of malformations?
Less than 8.5% - Tends to be normal (3.4%)
Greater than 8.5% - (22.4%)
When is the most noticible increase in insulin resistance? What may need to happen?
Most noticable at 28-32 wks
May need medication
Describe the management of patients with Diabetes in pregnancy.
What are the 2 screening strategies for gestational diabetes?
1 step - doing a 1 time GTT, and setting the values slightly lower. 2 step normal (95) vs 1 step normal (92)
How does increasing blood sugar levels in a pregnant mother affect adverse outcome in the baby?
It leads to increased complications for the baby
Pregnant individuals with Type 1 diabetes are at risk for what?
DKA - pregnant women can go into DKA with blood sugar in the 200s vs the 300-400s
