3.1.2 Diabetes in Pregnancy

Question 1

Explain the physiology occuring in the 2nd and 3rd trimester that can affect glucose levels?

Answer 1

Question 2

What are the medications used for pregnancy diabetes?

Answer 2

Glyburide

Metformin

Insulin

Question 3

How does regular insulin compare to NPH insulin?

Answer 3

Question 4

What are some of the neonatal complications associated with a baby who had a mother with DM?

Answer 4

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

Question 5

What is pregestation vs gestational diabetes?

Answer 5

Pre - diagnosed prior to pregnancy

Gestational - diagnosed during the pregnancy

Question 6

What are the fetal complications of Preexisting DM?

Answer 6

Spontaneous abortions

Congenital malformations

Question 7

What are some medications not allowed for pregnancy diabetes?

Answer 7

Thiazolidinediones

DPP-4 inhibitors

GLP-1 receptor agonist

Question 8

Describe the delivery schedule for a baby whose mother has pregnancy diabetes.

Answer 8

Question 9

What are the fetal complications with GDM?

Answer 9

Basically overgrowth:

Hydramnios

Macrosomia

Stillbirth

Question 10

Pregestational diabetes increases the risk for?

Answer 10

Preeclampsia, uteroplacental insufficiency, IUGR, and preterm birth

Question 11

What is the concept of Gestational Diabetes Mellitus?

Answer 11

Carbohydrate intolerance that begins or is 1st recognized in pregnancy

Some women have previously unrecognized overt diabetes

Question 12

Diabetic mother will have an increased or decreased risk for infection?

Answer 12

Diabetic mothers will have an increased risk for infections throughout pregnancy

Post-operative would infections - if baby is delivered by C-section

Question 13

What are the effects of elevated estrogen in the first trimester?

Answer 13

Stimulate Beta cell hyperplasia + insulin secretion

Enhancing insulin sensitivity - episodes of maternal hypoglycemia

Question 14

Describe the fetal care for babies with a mother that has pregnancy diabetes

Answer 14

Question 15

How do HbA1c levels relate to rate of malformations?

Answer 15

Less than 8.5% - Tends to be normal (3.4%)

Greater than 8.5% - (22.4%)

Question 16

When is the most noticible increase in insulin resistance? What may need to happen?

Answer 16

Most noticable at 28-32 wks

May need medication

Question 17

Describe the management of patients with Diabetes in pregnancy.

Answer 17

Question 18

What are the 2 screening strategies for gestational diabetes?

Answer 18

1 step - doing a 1 time GTT, and setting the values slightly lower. 2 step normal (95) vs 1 step normal (92)

Question 19

How does increasing blood sugar levels in a pregnant mother affect adverse outcome in the baby?

Answer 19

It leads to increased complications for the baby

Question 20

Pregnant individuals with Type 1 diabetes are at risk for what?

Answer 20

DKA - pregnant women can go into DKA with blood sugar in the 200s vs the 300-400s