Chapter 29

Question 1

Diabetes and pregnancy

Answer 1

-2:1000 have preexisting DM- Type I or II
-3-9% will develop gestational diabetes- the onset of glucose intolerance during pregnancy, more likely to become Type II diabetic later in life(20-50% in 5-10 years)
GDM A1- diet controlled
GDM A2- diet and insulin controlled

Question 2

Risk Factors for Gestational Diabetes Mellitus

Answer 2

Obesity (BMI >25)
Maternal age older than 25 years
Previous birth outcome often associated with GDM
Gestational diabetes in previous pregnancy
History of abnormal glucose tolerance level
History of diabetes in close relative
Member of high-risk ethnic group

Question 3

effects of preg on diabetes 1st half of preg

Answer 3

(UP TO 20 WKS.) Insulin release increases and patient tends to be HYPOGLYCEMIC

Question 4

effects of preg on diabetes 2nd half of preg

Answer 4

(After 20 wks) Placental hormones (estrogen, progesterone, HPL) rise sharply and create insulin resistance which helps with glucose being available for fetal growth– patient tends to be HYPERGLYCEMIC

Question 5

Insulin needs 1st trimester

Answer 5

insulin needs reduced

Question 6

Insulin needs 2nd trimester

Answer 6

insulin needs increase with insulin antagonists

Question 7

Insulin needs 3rd trimester

Answer 7

insulin needs continue to rise and then level off at 36 weeks

Question 8

Insulin needs at birth

Answer 8

expulsion of placenta, and decreasing hormonal levels ,causes prepregnancy stabilization of insulin

Question 9

Signs and Symptoms of Maternal Hypoglycemia

Answer 9

Shakiness (tremors)
Sweating
Pallor and cold, clammy skin
Disorientation, irritability
Headache
Hunger
Blurred vision

Question 10

Signs and Symptoms of Maternal Hyperglycemia

Answer 10

Fatigue
Flushed, hot skin
Dry mouth, excessive thirst
Frequent urination
Rapid, deep respirations
Odor of acetone on breath
Drowsiness
Headache
Depressed reflexes

Question 11

maternal effects of diabetes on pregnancy

Answer 11

PIH
UTI
KETOACIDOSIS
LABOR DYSTOCIA
BIRTH TRAUMA AND INCREASED C-SECTIONS
UTERINE ATONY POST PARTUM

Question 12

fetal and neonatal effects of diabetes

Answer 12

INTERUTERINE FETAL DEATH (IUFD)
CONGENTIAL ABNORMALTIES
MACROSOMIA
IUGR
PRETERM LABOR w/ RDS
BIRTH INJURY
REBOUND HYPOGLYCEMIA
POLYCEMIA
HYPERBILIRUBINEMIA
HYPOCALCEMIA
RDS

Question 13

diet for diabetes in preg

Answer 13

2200-2500 cals/day
3 meals/ day and 2-3 snacks
50% CHO’s, 20% protein, 25% FAT
Weight gain consistent with normal pg., no ketoacidosis and minimize wide fluctuations in blood sugar levels

Question 14

exercise for diabetes in preg

Answer 14

Moderate amount helps to maintain blood sugar level

May be contraindicated with hypertension, neuropathy or other vascular problems

Question 15

Glucose level monitoring

Answer 15

-Blood Glucose- up to 6-8/day
-Ideally keeping in the range of 65-95 premeal/ fasting to prevent complications
-With lowered renal threshold for glucose, urine glucose levels do not reflect blood glucose levels and should not be done for assessment
HbA1c

Question 16

fetal surveillance for diabetics

Answer 16

Serum AFP (MSAFP)
Ultrasounds
Kick counts
Non stress testing
Biophysical profiles
Lecithin/spingomyelin ration (L/S RATIO)

Question 17

gestational diabetes

Answer 17

Risk Factors for Gestational Diabetes

Definition: CHO intolerance that develops usually after 20 weeks- Test at 24-28 weeks

Question 18

how to identify gestational diabetes

Answer 18

Glucose Challenge Test (24-28 wks)
If >140 mg THEN DO—-
* Oral Glucose Tolerance Test– FBS, 1hr.,2hr.,3hr.tests
If two or more values are abnormal
according to ACOG guidelines (pg. 641 )

• If symptomatic before initial testing @ 24-28 wks.
  draw blood sugar- >126 (fasting) OR >200 (non-fasting)
  THEN NO FURTHER TESTING IS NEEDED AND A
  DIAGNOSIS OF GDM IS MADE

Question 19

Gestational diabetes

Answer 19

Not associated with ketoacidosis, congenital malformations or spontaneous AB’s
Maternal hyperglycemia during 3rd trimester
Associated with increased neonatal morbidity and mortality
Major fetal complications: Macrosomia and rebound hypoglycemia
Other neonatal complications can occur

Question 20

gestational diabetes management

Answer 20

Diet/Exercise management similar to
Type I & II
Do FBS’s and 2 hour postprandial blood sugars
Fetal surveillance– kick counts, Non stress testing, amniotic fluid index, BBP

Question 21

hyperemesis gravidarum

Answer 21

Excessive N&V that leads to electrolyte imbalance, dehydration and/or a marked weight loss of 5% or more
Exact cause unknown, Possibly endocrine, metabolic, fragments of chorionic villus, decreased motility of G.I. tract

Question 22

hyperemesis gravidarum treatment

Answer 22

rehydration, starvation possible NG tube or parental nutrition, emotional support, electrolyte replacement
Antiemetics controversial due to reported fetal anomalies
Prognosis: rapid recovery or slow progress