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