Diabetes Flashcards
Does insulin cross placenta
No
Effects of preexising diabetes in pregnancy: maternal
Preeclampsia Eclampsia Diabetic ketoacidosis Worsening of preexising nephro/retinopathy Infection: UTI Polyhydramnios: fetal polyuria C-section Postpartum hemorrhage Mortality
Effects of preexisting diabetes on pregnancy
Fetal
Only in preexisiting: Miscarriage and SA Congenital malformations: anencephaly, spina bifida, VSD, sacral agenesis, causal regression. Both pre and GDM Macrosomia IUGR Stillbirth Preterm (esp with preeclampsia) Delayed fetal lung maturity Shoulder dystochia
Neonatal complications of diabetic mothers
RDS: hyperglycaemia interferes with surfactant synthesis
Hypoglycaemia: due to pancreatic hyperplasia and excess insulin secretion in the neonate
Hypocalemia
Polycythemia: hyperglycaemia stimulate fetal EPO production
Hyperbilirubemia and jaundice: due to prematurity and polycythemia
HbA1c goal prior to conception?
Risk factors that warrant at OGTT test at first prenatal visit
Fx DM History of GDM Glycosuria History of unexplained miscarriage or still birth Prior macrosomia Obesity > 30 BMI Age >35 PCOS Current use of glucocorticoid Prior macrosomia
All pregnant woman should be screen for GDM when?
24-28 weeks
Follow up screening and diagnosis of GDM postpartum
6 week OGTT, then every 3 year
One step OGTT values
Fasting
1 h
2 h
Fasting > 92 mg/dl (5.1)
1 h > 180 mg/dl (10,0)
2 h > 153 (8,5)
2/3 = GDM 1/3 = IGT
Recommended glycemic control values
Fasting
1h postprandial
Between 2-4 am
F: 60-90 mg/ dl
1h: 60 mg/dl
First trimester lab GDM and 2nd trimester
Same for 1st and 2nd:
HbAc1
Spot urine protein-creatinine ratio
Capillary bs levels: 4-7 times
1st: TSH and free T4, serum creatinine, BUN
2nd; NST, BPP
What mechanisms predisposes women to diabetes during pregnancy?
Increase in GH and cortisol = insulin antagonists
hPL (from placenta) = insulin antagonists
Increased insulin degradation by placental insulinase
