CLIN: Gestational Diabetes

Question 1

What is gestational diabetes?

Answer 1

Glucose intolerance diagnosed in pregnancy

*Pregnancy = insulin resistance state*

Question 2

What are risk factors for gestational diabetes?

Answer 2

Question 3

When do you screen for gestational diabetes?

Answer 3

Screen all patients between 24-28 weeks w/ 2 step approach

1. 1 hr glucola (50 ms, glucose tolerance test) –> abnormal 130/140
2. If you fail, you have to do a 3 hr glucola test

If any values are over 200mg –> automatic fail and you send staight to diabeteic education

Question 4

In the gluocse tolerance test, how many abnormal values do you need for a positive?

Answer 4

2

Question 5

How do you treat gesational diabetes?

Answer 5

With dietary changes (50 % carbs, 25% protein 25% fat) x4 a day + increased exercise

Testing regimen = daily monitoring

Question 6

What are the maternal risks of gestational diabetes?

Answer 6

Preclampsia (hypertension), LGA (large gestational infants), delivery trauma (to the baby and shoulder disocia –> wide shoulders get stuck and might not get baby out! SCARY!)

Future risk of developing type 2 DM increases a ton

Question 7

What are the potential newborn complications of gestational diabetes?

Answer 7

Macrosomia (big babies)

Neonatal hypoglycemia (used to sugar, and then it tanks so they have to feed all the time)

Hyper-bilirubinemia (juandice)

shoulder dystocia

birth trauma

Stillbirth (morbidly obese moms have high rsik of this)

Increased risk of childhood and adult onset obesity + diabetes (patients that are obese can increase the risk of their children being obese, just from being pregnant)

Question 8

What are some drugs you could give for gestational diabetes?

(FYI diet usually fixes 70-80%)

Answer 8

Oral Hypoglycemic Agents: Metformin (crosses placenta) + Glyburide

Insulin (does not cross placenta) –> GOLD STANDARD

Question 9

What is A1?

Answer 9

Gestational diabetes, controled w/ diet alone

lower risk, no monitoring

Question 10

What is A2 on the white’s classification system?

Answer 10

Gestational diabetes, controlled with diet + meds

Question 11

When do you use metformin?

Answer 11

If they are diabetic prior to pregnancy (it inhibits gluconeogenesis + glucose absorption + stimulates glucose uptake)

Patients are already on this and we just keep them on it during pregnancy

500mg x2

Question 12

What is glyburide?

Answer 12

Sulfonylurea

Not really that good –> use insulin or metformin first

no long term data

Question 13

What is insulin?

Answer 13

GOLD STANDARD

starting dose .7-1.0 w/ needle

Question 14

Antepartum Surveillance

Answer 14

Monitor baby (identify problem before its too late)

Montior starts @ 32 weeks

When to deliver:

A1DM + A2 DM –> after 39 weeks

Preexisting diabetes –> 38-39 weeks

Poorly controlled –> 37-39 weeks

Question 15

What do we do for intrapartum management (during birth)

Answer 15

Reduce risk of preclampsia, LGA, and shoulder dystocia

*optimal glycemic control during labor –> this affects how uterus works (effective contractions/labor progressions)*

Question 16

What do you do after the mom has baby?

Answer 16

Give them a 2 hr oral GGT to see if they really did have type 2 diabetes undiagnosed

Check every couple years since they have an increase risk

Question 17

MEMORIZE!!!!

Answer 17

Question 18

What is the criteria to be diagnosed with diabetes mellitus postpartum?

Answer 18

FPG > 125 or 2 hr glucose > 199

Question 19

What is the criteria to be diagnosed with impaired fasting glucose postpartum?

Answer 19

FPG 100-125 or 2 hr glucose 140-199

Refer for weight loss + physical activity (consider metformin)

Question 20

For testing a postpartum patient you give them either FPG or 75g, 2 hr OGTT at 4-12 weeks postpartum. What is a normal (-) test finding?

Answer 20

FPG < 100 or 2 hr glucose <140mg

Assess glycemic status every 1-3 years

Question 21

Any higher then ______ is abnormal for pregnancy.

Answer 21

140/90

Question 22

If you sceen before 24 weeks do you need to screen again?

Answer 22

yes! between 24-28 weeks