Chapter 29

Question 1

what are the metabolic changes associated with pregnancy?

Answer 1

alterations in maternal glucose metabolism, insulin production, and metabolic homeostasis
Glucose is the primary fuel for the fetus
Glucose crosses the placenta, insulin does not
Insulin needs increase during the first trimester
Diabetogenic effect in second and third trimesters

Question 2

what are the maternal risks/complications associated with pre gestational diabetes?

Answer 2

Hydramnios/polyhydramnios
Ketoacidosis
Hypoglycemia/hyperglycemia

Question 3

what are the fetal and neonatal risks/complications caused by pregestational diabetes?

Answer 3

IUFD – intrauterine fetal demise
Congenital malformations
Hypoglycemia at birth

Question 4

Antepartum pre gestational diabetes management?

Answer 4

Diet
Exercise
Insulin therapy
Monitoring blood glucose levels (AC/HS)
Urine testing (protein/ketones)
Complications requiring hospitalization
Fetal surveillance (NST, BPP)
Determination of birth date and mode

Question 5

intrapartum management for pre gestational diabetes

Answer 5

Monitoring for dehydration
Blood glucose levels carefully monitored
Continuous EFM
Intravenous infusion
Possible cesarean birth for macrosomia

Question 6

what is severe hypothyroidism associated to

Answer 6

infertility and increased risk of miscarriage