Class 3: Gestational Diabetes and Pre-Existing Diabetes Flashcards
define: gestational conditions
- disorders that did not exist before pregnancy
what are 3 classifications of diabetes
- type 1
- type 2
- gestational diabetes
what is gestational diabetes
- any degree of glucose intolerance with onset or recognition during pregnancy
what risks does GDM provide to the pregnant person and fetus (14)
- 2x risk of HTN disorders (pre-eclampsia)
- infection
- trauma and injuries during birth
- macrosomia
- c-section birth
- should dystocia
- pre-maturity
- fetal and neonatal hypoglycemia
- IUGR
- intrauterine fetal death
- fetal lung immaturity
- hyperbilirubinemia
- hypocalcemia
- polycythemia
- birth trauma
what are risk factors for developing GDM (10)
- age > 35
- BMI > 30
- prediabetes
- high risk groups
- parents and sibling w T2DM
- personal history of GDM
- previous infant >4 kg birthweight (macrosomia)
- on glucocorticoids
- acanthosis nigricans or PCOS
- current pregnancy –> fetal macrosomia or polyhydramnios
what populations are at high risk for developing GDM
- african
- arab
- asian
- hispanic
- indigenous
- south asian
universal screening for GDM is done when?
- screen all pregnant people between 24-28 weeks
what is the preferred approach for screening & diagnosing GDM
- random non-fasting 50g OGTT
what BG lvl is normal vs GDM after a random non-fasting 50g OGTT?
- normal = 1hr PG <7.8
- GDM = 1hr PG > 11.1
what is included in antepartum mngmt of GDM (5)
- diet **
- exercise **
- monitoring BG lvls **
- insulin therapy
- fetal surveilance (freq and degree depend on several factors)
*** = first line, trial for 2 weeks
what is included in intrapartum mngmt of GDM (3)
- monitor glucose
- hydration
- fetal monitoring
what is included in postpartum mngmt of GDM (4)
- encourage chest/breastfeeding for at least 4 months (helps stabilize newborn BG, decreases r/o birther T2DM)
- screening for T2DM during the first 6 weeks to 6 months postpartum
- education re: planning for another pregnancy
- stop insulin and diabetic diet
what are glycemic targets for fasting? 1hr PP? 2hr PP?
- fasting: 3.8-5.2
- 1hr PP: 5.5-7.7
- 2hr PP: 5-6.6
expected weight gain in pregnancy depends on…
- starting BMI
for a BMI of 18.5-24.9 “normal weight”, what is expected weight gain?
- 11.5-16 kg OR 25-35 lbs
what education/counselling is given during prenatal visit regarding GDM (2)
- kick counts
- S&S of infection, HTN, other
what FH assessments are included in prenatal visits r/t GDM (5)
- FHR
- SFH
- leopold’s maneuvers
- fetal mvmts
- enhanced fetal monitoring (BPP, NST)
what physical assessments are done in prenatal visits r/t GDM (5)
- refer back to class 2 for details for routine prenatal care physical exam
- general appearance
- BMI
- VS
- urine dip & UA
what history/subjective assessment is done in prenatal visits r/t GDM (3)
- routine prenatal care history/interview
- ask how coping mentally
- specific history for person w GDM
what is T2DM
- group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both
T2DM may be caused by either or both of the following (2)
- impaired insulin secretion
- inadequate insulin action in target tissues
what are risks and complications of pre-gestational diabetes (7)
- perinatal mortality
- congenital malformations
- HTN
- preterm delivery
- large for gestational age infants
- c-section birth
- neonatal morbidities
describe preconception counselling for pregestational DM (4)
- folic acid**
- optimize glucose mngmt prior to pregnancy
- review meds in prep for pregnancy
- review complications of diabetes
what are fetal and newborn risks of pregestational DM (6)
- large for gestational age infants
- macrosomia
- sudden still birth
- congenital anomalies
- birth injuries
- hypoglycemia birth
what is strongly encouraged for pregestational diabetes
- preconception counseling
what is included in assessment for GDM (4)
- interview
- physical exam
- lab tests
- fetal health surveilance
what lab tests are done for GDM (5)
- routine prenatal tests
- 24-hr urine protein
- Cr Cl
- HbA1C
- retinal exam
what is included in fetal health surveilance for GDM (5)
- FHR
- SFH
- leopold’s maneuvers
- fetal mvmts/kick counts
- enhanced fetal monitoring (NST, BPP) in late 2nd and 3rd trimester depends on indiv circumstances
what is included in antepartum care for GDM (6)
- diet
- exercise
- monitor BG levels
- insulin therapy
- complications requirinh hospitalization
- determination of birth date and mode of delivery
what is included in intrapartum care for GDM
- close monitoring of BG lvls and dehydration
what is included in postpartum care for GDM (4)
- insulin requirements decrease substantially in immediate postpartum period
- chest/breastfeeding
- monitor for postpartum complications
- family planning and contraception
describe insulin needs in 1st semester (2)
- need is reduced d/t increased insulin production by pancreas and increased peripheral sensitivity
- NV and decreased food intake by mother and glucose transfer to embryo and fetus contribute to hypoglycemia
escribe insulin needs in 2nd trimester
- insulin need increases as placental hormones, cortisol, and insulinase act as insulin antagonists = decreased effect of insulin
describe needs of insulin in 3rd trimester
- insulin requirements gradually increase until about 36 weeks of gestation
describe needs of insulin on day of birth
- maternal insulin requirements drop drastically to approach prepregnancy levels
describe insulin requirements when breastfeeding
- maintains lower insulin requirements
describe insulin needs of nonbreastfeeding pregnant people
- returns to pre-pregnancy levels in 7-10 days
GDM and pre-existing DM can …
- increase risk in pregnancy of poor outcomes for both pregnant person and fetus/newborn
what is particularly important for those w pre-existing diabetes and those who had GDM in a previous pregnancy
- preconception care
