Clin: Medical Conditions in Pregnancy - Wootton Flashcards
when is gestational diabetes screening done?
between weeks 24-28
- 50gm 1 hr oral glucose challenge test (>130-140 = abnormal)
- may perform earlier screen in pt with risk factors
what if a GDM screen is abnormal?
repeat test with 3 hour 100gm oral load glucose test (fail 3 hour with 2 or more abnormal values)
what are the risk factors for development of GDM?
- obesity
- previous hx GDM
- strong family hx of DM
- known glucose intolerance
what are the maternal complications of GDM?
- increased risk of gestational HTN
- increased risk of preeclampsia
- greater risk of cesarean delivery
- increase risk of developing diabetes later in life
what are the fetal complications of GDM?
- macrosomia
- neonatal hypoglycemia
- hyperbilirubinemia
- operative delivery
- shoulder dystocia
- birth trauma
- stillbirth
how often is fetal testing performed?
weekly
- biophysical profiles and non-stress tests
- US for estimated fetal weight (if greater than 4500gm -> recommend cesarean delivery)
can you wait for spontaneous labor or EDD if all testing, growth and glycemic control are ok?
yes!
antepartum - diet controlled GDM
Class A1
- initially frequent monitoring of blood glucose
- typically no treatment required
antepartum - oral or insulin managed GDM
Class A2
- hourly glucose monitoring
- insulin drip
- continuous fetal monitoring in labor
there is a direct link between birth defects and what, in the period of embryogenesis?
increasing glycosylated hemoglobin levels (HgBA1C)
- six-fold increase in risk of congenital anomalies
what are the maternal intrapartum complications of GDM?
worsening nephropathy and retinopathy
- increased risk of developing preeclampsia
- greater risk of diabetic keto acidosis
what are the fetal intrapartum complications of GDM?
increased risk of spontaneous abortion
- anatomic birth defects (sacral agenesis, cardiac)
- fetal growth restriction and prematurity
diabetes onset at age 20 or older, or with duration less than 10 years
Class B
diabetes onset at age 10-19, or duration of 10-19 years
Class C
diabetes onset before age 10, or duration greater than 20 years
Class D
diabetic nephropathy is considered what class in Whites classification?
Class F
proliferative nephropathy is considered what class in Whites classification?
Class R
retinopathy and nephropathy is considered what class in Whites classification?
Class RF
ischemic heart disease is considered what class in Whites classification?
Class H
prior kidney transplant is considered what class in Whites classification?
Class T
what is condiered good glycemic control?
- fasting glucose less than 95mg/dL
- two hour postprandial less than 120mg/dL
- control with diet, oral hypoglycemic medications (metformin) or insulin (preferred and recommended first line)
- exercise half an hour after meals
antepartum maternal evaluation
- renal: 24 hour urine collection every trimester
- cardiac: EKG
- ophthalmic: detailed eye exam
- glycemic control: finger stick blood values
antepartum fetal evaluation
- early dating US
- detailed fetal anatomy US including fetal echocardiogram
- biocehmical testing for congenital malformations in first trimester (11-13 wks) or quad screen (16-21 wks)
- fetal growth US every 2-4 wks
- fetal testing (NST/BPP) every wk starting 32 wks
what do delivery options depend on?
estimated fetal weight and glycemic control