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Women's Health Theory > Diabetes in Pregnancy > Flashcards

Diabetes in Pregnancy Flashcards

1
Q

What is type III diabetes?

A

Gestational/pregnancy developed diabets

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2
Q

What percentage of diabetes in pregnancy is GDM?

A

85%

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3
Q

Risk factors for gestational diabetes:

A

-advanced maternal age (>= 35; higher risk >=40)
-previous infant >9 lbs
-prepregnancy BMI > 30
-Hx GDM (40-50% recurrence)
-HbA1C > 5.7
-hx adverse obstetric outcome associated with GDM

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4
Q

What are the 2 biggest risk factors of gestational diabetes?

A

-Hx GDM (40-50% recurrence)
-HbA1C > 5.7

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5
Q

Who gets screened?

A

everyone! Universal screening is performed.

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6
Q

When does universal screening occur?

A

24-28 weeks

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7
Q

What test is performed for initial screening?

A

50 gram 1 hours glucose challenge

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8
Q

What is considered ABNORMAL for 1 hour 50 g glucose challenge

A

> 130 (80% sensitivity)
140 (90% sensitivity)

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9
Q

What is the next step for glucose testing after a failed 1 hour?

A

3 hours 100 gram challenge

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10
Q

What are the parameters for 100 g 3 hour test?
-fasting
-1 hr
-2 hr
-3 hr

A

fasting > 95
1 hr > 180
2 hr > 155
3 hr > 140

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11
Q

How many parameters must you fail in the 3 hour to be diagnosed with GDM?

A

2

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12
Q

How do you target underlying type II diabetes

A

-HbA1C > 5.7%
-GDM previous pregnancy
-Hx cardiovascular disease
-Htn
-HDL<35 Triglyceride >250
-PCOS
-First degree relative, physical inactivity, high risk ethnic group

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13
Q

Pregnancy risks with gestational diabetes

A

-LGA
-Macrosomia (>4500 mg)
-increased risk operative delivery
-shoulder dystocia
-brachial plexus injury
-increased risk C/S

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14
Q

What occurs when the mothers blood brings extra glucose to the fetus?

A

-fetus makes more insulin to handle excess sugar
-extra glucose gest stored as fat and fetus becomes larger than normal

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15
Q

What are risks to the birthing mom with GDM?

A

-hypertension
-preeclampsia
-birth trauma

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16
Q

What are the risks to the baby? (metabolic complications)

A

-hypoglycemia
-hypocalcemia
-hyperbilirubinemia

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17
Q

How do you treat GDM? First line

A

-Personalized meal plan (35-40% carbs, 20% protein, 40% fat)
-moderate exercise
-nutritional consult

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18
Q

If unable to get GDM in control with lifestyle modifications then step 2:

A

-insulin

19
Q

Blood glucose monitoring goals
-fasting
-postprandial (1 and 2 hr)

A

fasting <95
1 hr <140
2 hr <120

20
Q

What is A1 GDM? A2?

A

A1: able to be controlled with diet & exercise
A2: medication involved

21
Q

A2 prenatal care plan
Antenatal testing? Delivery suggestions?

A

-weekly antenatal testing begins at 32 weeks
-deliver 39-40 weeks
-consider C/S if estimated fetal weight (EFW) is > 4,500 grams

22
Q

Postnatal care?
-testing

A

Perform the 75 gram f2 hr oral glucose challenge at 6 weeks postpartum
-Diabetes screening annual for 5-10 years

23
Q

What is the risk of future DM in a pt that had GDM?

A

50-70% increased risk

24
Q

What can increase the risk of recurrence of GDM?

A

A Short interval - encourage contraception!

25
Q

Pregestational diabetes:
- normal fasting vs. DM fasting
- normal 50 g 1 hr vs. DM

A

Normal <110 DM >126
Normal 50 g 1 hr <140; DM > 200

26
Q

Preconception counseling for individuals with pregestational diabetes

A

-immunization: rubella
-screening: HIV, RPR, HBSAg, CF
-prenatal vitamins
-age related risk
-fetal risks
-maternal risks

27
Q

Fetal risks - pregestational diabetes

A

-miscarriage
-congenital malformations: remember orgnogenesis is done by 9 weeks EGA
- NO increased risk of anueploidy
-macrosomia ~ increases risk of birth trauma
-intrauterine growth restriction

28
Q

Specific congenital anomalies - pregestational diabetes

A

Cardiac: VSD (ventricular septal defect)
CNS: anencephaly; spina bifida

29
Q

Diagnosis of intrauterine growth restriction

A

baby is at <10th percentile of the birthweight

30
Q

Pregestational diabetes: preterm delivery

Etiologies (contributors)

A

-polyhydramnios
-preeclampsia
-poor glycemic control
-worsening nephropathy

31
Q

Perinatal risk: pregestional diabetes

what could go wrong during labor

A

-hyperbilirubinemia
-hypoglycemia
-respiratory distress
-hpocalcemia
-cardiomyopathy
-polcythemia
-hypothermia

32
Q

Pregestional diabetes: maternal cardiovascular risks

A

-Chronic htn: stroke, preeclampsia, placental abruption
-Coronary artery disease (CAD)
-Preeclampsia

33
Q

Pregestaional diabetes: maternal renal risks

A

-Nephropathy: increases risk of preeclampsia [increases risk of preterm delivery and IUGR]
-GFR is impaired in 67% diabetic pregnancies
-increased risk UTI

34
Q

Pregestional diabetes

Maternal ocular risks

A

retinopathy
-unlikely to develop during pregnancy
-if present before, it often worsens
-usually transient
-laser therpy is effective

35
Q

Pregestational diabetes

Maternal nueropathy

A

peripheral neuropathy
-does not get worse with pregnancy
autonomic neuropathy
-does not worsen

36
Q

Pregestational diabetes

Maternal nueropathy: what autonomic risks increase?

A

-hyperemesis
-hypoglycemia unawareness
-orthostatic hypotension
-urinary retention

37
Q

Pregestational diabetes

Prenatal evaluation: labs!

A

-Routine labs (Pcp, Hct, T&S)
-Hgb A1C
-BUN, Cr
-Urinalysis
-24 hours urine
-TSH
-Blood pressure
-EKG
-Eye exam

anything that the small vessels are a big part of*

38
Q

Pregestational Diabetes

Prenatal care: First trimester U/S

A

-confirm EDC
-verify viability

39
Q

Pregestational Diabetes

Prenatal care: Second trimester U/S

A

-evaluate for congenital malformations

40
Q

Quick reminder on peak and duration of insulin:

-Humalog (lispro)
-Regular
-NPH
-Glargine

A

-Humalog: peak 1 hr; duration 2 hr
-Regular: peak 2 hr; duration 4 hr
-NPH: peak 4 hr; duration 8 hr
-Glargine: peakless; duration 20 hr

41
Q

Pregestational diabetes

Fetal surveillance

A

-fetal kick counts
-ultrasound
-weekly antenatal testing

42
Q

Pregestational diabetes

Prenatal care: fetal surveillance - when to begin:
-fetal kick count
-ultrasound
-weekly antenatal testing

A

-fetal kick count: after 28 weeks
-US: every 4 weeks after 28 weeks
-Weekly antenatal testing: from 32-36 weeks

43
Q

Pre-gestational diabetes
-Normal fasting/50G
-Impaired fasting/50G
-DM fasting/50G

A

-Normal fasting/50G: <110/<140
-Impaired fasting/50G: 110-126/140-199
-DM fasting/50G: >126>200

Women's Health Theory (7 decks)

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