Chapter 29 Flashcards
Diabetes and pregnancy
-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
Risk Factors for Gestational Diabetes Mellitus
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
effects of preg on diabetes 1st half of preg
(UP TO 20 WKS.) Insulin release increases and patient tends to be HYPOGLYCEMIC
effects of preg on diabetes 2nd half of preg
(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
Insulin needs 1st trimester
insulin needs reduced
Insulin needs 2nd trimester
insulin needs increase with insulin antagonists
Insulin needs 3rd trimester
insulin needs continue to rise and then level off at 36 weeks
Insulin needs at birth
expulsion of placenta, and decreasing hormonal levels ,causes prepregnancy stabilization of insulin
Signs and Symptoms of Maternal Hypoglycemia
Shakiness (tremors) Sweating Pallor and cold, clammy skin Disorientation, irritability Headache Hunger Blurred vision
Signs and Symptoms of Maternal Hyperglycemia
Fatigue Flushed, hot skin Dry mouth, excessive thirst Frequent urination Rapid, deep respirations Odor of acetone on breath Drowsiness Headache Depressed reflexes
maternal effects of diabetes on pregnancy
PIH UTI KETOACIDOSIS LABOR DYSTOCIA BIRTH TRAUMA AND INCREASED C-SECTIONS UTERINE ATONY POST PARTUM
fetal and neonatal effects of diabetes
INTERUTERINE FETAL DEATH (IUFD) CONGENTIAL ABNORMALTIES MACROSOMIA IUGR PRETERM LABOR w/ RDS BIRTH INJURY REBOUND HYPOGLYCEMIA POLYCEMIA HYPERBILIRUBINEMIA HYPOCALCEMIA RDS
diet for diabetes in preg
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
exercise for diabetes in preg
Moderate amount helps to maintain blood sugar level
May be contraindicated with hypertension, neuropathy or other vascular problems
Glucose level monitoring
-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
fetal surveillance for diabetics
Serum AFP (MSAFP) Ultrasounds Kick counts Non stress testing Biophysical profiles Lecithin/spingomyelin ration (L/S RATIO)
gestational diabetes
Risk Factors for Gestational Diabetes
Definition: CHO intolerance that develops usually after 20 weeks- Test at 24-28 weeks
how to identify gestational diabetes
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
Gestational diabetes
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
gestational diabetes management
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
hyperemesis gravidarum
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
hyperemesis gravidarum treatment
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
