Diabetes Flashcards
Incidence of any type of diabetes in pregnancy
7% of all pregnancies, (86% of those cases are GDM)
GDM is associated with what risks?
- Developing preeclampsia
- Having a c/s
What percentage of GDM patient will develop T2DM within 22-28 years after pregnancy?
70%!!!!!
Fetal risks when mom has GDM?
- Macrosomia
- Neonatal hypoglycemia
- Hyperbilirubinemia
- Shoulder dystocia
- Birth trauma
When is GDM screening?
24-28 weeks
What is the screening test for GDM?
1 hour glucose GCT (50 g)
1 hour 50 g GCT cut off
130-140 mg/dL
Carpenter and Coustan cutoff for 3 hour GTT
Fasting 95
1 hour 180
2 hour 155
1 hour 140
Is a woman still at increased risk of adverse perinatal outcomes if she only has 1 abnormal value on 3 hr GTT?
Yes!
How often should GDM patients check their blood sugar?
AM Fasting and 1-2 hours post prandial
Goals for blood glucose of GDM patient’s?
Fasting < 95
1 hour post prandial < 140
2 hour post prandial < 120
Treatment for GDM
- Lifestyle- diet and exercise
- Insulin
- Metform
Typical starting dose for insulin for GDM?
0.7-1 unit/kg daily - divided among multiple injections using long and short acting insulin
Does insulin cross the placenta?
Nope!
Short acting insulins
Lispro
Aspart
Onset- 1-15 minutes
Peak action at 1-2 hours
Long acting insulins
NPH
Glargine (lantus)
Determir
Onset 1-3 hours
MOA of metoformin
Biguanide
Inhibits hepatic gluconeogenesis and glucose absorption and stimulated glucose uptake in peripheral tissues
Does metformin cross the placenta?
Yes! Levels can be as high as maternal concentrations
If on metformin for PCOS when should you discontinue metformin?
After frist trimester??
Limited evidence to suggest a decrease risk of adverse pregnancy outcomes (including first trimester loss)
Counseling for Metformin in treating GDM?
- Lack of superiority when compared with insulin
- It crosses placenta!
- Absence of long-term data in exposed offspring
Dosage for Metformin for GDM?
500 mg nightly for 1 week, then increase to twice daily
Max dose: 2500-3000 mg/day
**Check Creatinine!
Fetal surveillance for GDM either poorly controlled or on medications?
Antenatal testing starting at 32 weeks
no consensus regarding antenatal testing in GDMA1
What fluid abnormality can be seen in babies w/ GDM moms?
Polyhydramnios
Results from fetal hyperglycemia.
Can incorporate serial measures of amniotic fluid
Delivery of GDM patients
Good control, no other complications = term
Good control + medical therapy = 39 weeks
Poor control = 37 weeks
In GDM patients, c/s is recommended for what EFW?
4,500 g
5,000 g for non-GDM
Postpartum screening for GDM
12 weeks postpartum
Fasting glucose and 75 g 2 hour GTT
Early labor glucose checks for GDM?
AC, QHS (before meals and at night)
or
Q4 hours
Active labor glucose checks for GDM?
q1-2 hours
insulin drip + D5 if high blood glucose
Screening for pre-gestational diabetes..
Who needs it?
Early 1 hour GCT
Obesity BMI >/= 30
Prior macrosomia/SD/Stillbirth/GDM
PCOS
Fm Hx of diabetes
Hyperlipidemia
Physical inactivity
Hx of CVD
Pre gestational Diabetes RISKS
Miscarriage
IUFD
IUGR, macrosomia
PTD
Congenital anomalies
What type of congenital anomalies are associated with pre gestational diabetes?
Caudal regression (sacral agenesis)
Cardiac anomalies (ASD, VSD, Transposition)
Neural Tube Defects (spina bifida, anencephaly)
Are there increased risks of fetal congenital anomalies for GDM?
Nope!!
(Risks of macrosmia, SD, hyperbilirunemia, etc but NOT congenital heart defects, etc)
Patient screens positive for pre gestational diabetes? Next steps?
- Referral to diabetes ed
- Start checking BG
- Start ASA 81 mg for Pre E PPx
- Detailed anatomy scan + fetal ECHO
- Antenatal Surveillance
