Diabetes in Pregnancy Flashcards
Glucose reaches fetus by_____
Facilitated diffusion.
Maternal Insulin _____ Placenta
cannot cross
GLUT ______ is involved in Facilitated diffusion.
GLUT 1 and GLUT 3
Fetus starts producing insulin @
12 wks
Inc insulin in fetus causes ____
1) Macrosomia
2) RDS even @ term
3) Neonatal Hyperglycemia.
Overt Diabetes
Diabetic mother conceiving.
Inc risk of Malformation coz free radicals.
Gestational diabetes.
A mother on conceiving becoming diabetic .
No chance of organ malformations as organogenesis has been completed.
Dx of Overt Diabetes
FBS= > 126 RBS= >200 HbA1C= > 6.5
Test to predict Chances of congenital malformations in Mothers.
HbA1c
Test to detect malformations in babies of diabetic mothers.
TIFFA
How to prevent Malformations in overt diabetes.
1) Strict glucose control.
2) Folic acid supplementation
dose 400 mcg / day
DOC in overt diabetes
Insulin
Oral hypoglycemic agents are C/I
MC system involved in malformation in overt diabetes.
CVS > CNS
MC congenital anomaly seen
VSD > NTD
Most specific congenital anomaly in over diabetes.
Caudal regression syndrome or Sacral agenesis.
MC cardiac anomaly in babies of diabetic mother
VSD
Most Specific Cardiac anomaly in overt diabetes.
TGA
Least common cardiac anomaly in overt diabetes.
TOF
ACOG Approach to Gestational Diabetes.
2 step approach.
1 st step : GCT- glucose challenge test @ 24-28 wks.
Give 50 gms glucose to mother and check levels after 1 hr
2nd step is 3 hr 100 gm glucose tolerance test in high risk females while fasting overnight. 4 samples are taken.if 2 or > 2 is abnormal it is dx as GDM.
Carpenter Coustan criteria.
criteria for diagnosing GDM via 3hr 100 gm OGTT FBS - 95 1 hr PP- 180 2 hr PP - 155 3 hr PP - 140 if 2 or > 2 abnormal = GDM
National diabetes criteria of India .
Criteria for Dx GDM via 3 hr 100 gm OGTT FBS- 105 1 hr PP - 190 2 hr PP - 165 3 hr PP - 145. if 2 or > 2 is abnormal = GDM
One step WHO approach to GDM.
Screening in high risk female. 2hr 75 gm OGTT. Fasting overnight. FBS. 75 gms glucose. 1 hr PP 2 hr PP. Criteria for 75 gm OGTT. FBS- 92. 1 hr PP - 180 2 hr PP - 152 if 1 or > 1 is abnormal = GDM.
DIPSI criteria
Followed in india. no fasting reqd. During a antenatal visit give 75 gms Glucose. check Blood sugar after 2 hrs. if > or = 120 - Glucose intolerance If > or = 140 - GDM if > or = 200 - overt diabetes.