Diabetes in Preganncy

Question 1

adverse pregnancy outcomes related to glucose control depednent on semester:

Answer 1

first semester: increase risk of fetal malformations

2 and 3rd trimester; increase risk of big baby and metabolic complications

Question 2

pathophysiology of diabetes in pregnancy

Answer 2

• high maternal & fetal glucose causes fetal
hyperinsulinemia
• promotes excess nutrient storage, resulting in big fetus • Energy assoc. with conversion of excess glucose into fat
causes depletion in fetal O2 levels Relative fetal hypoxia –
increase EPO

Question 3

how does diabetes in pregnancy lead to post natal hyperbilirubinemia

Answer 3

fetal hypoxia results in surges in adrenal
catecholamines causing
◦ HTN ◦ cardiac remodeling hypertrophy ◦ stimulation of erythropoietin, red cell hyperplasia, increased
HCT, Polycythemia in 5-10%
• High HCT lead to vascular sludging, poor circulation &
postnatal hyperbilirubinemia

Question 4

Insulin Requirements in Pregnancy

Answer 4

lower in first trimester because of morning sickness, higher as fetal needs increase

Question 5

Gestational Diabetes Risk Factors

Answer 5