Diabetes in Pregnancy Flashcards
What is type III diabetes?
Gestational/pregnancy developed diabets
What percentage of diabetes in pregnancy is GDM?
85%
Risk factors for gestational diabetes:
-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
What are the 2 biggest risk factors of gestational diabetes?
-Hx GDM (40-50% recurrence)
-HbA1C > 5.7
Who gets screened?
everyone! Universal screening is performed.
When does universal screening occur?
24-28 weeks
What test is performed for initial screening?
50 gram 1 hours glucose challenge
What is considered ABNORMAL for 1 hour 50 g glucose challenge
> 130 (80% sensitivity)
140 (90% sensitivity)
What is the next step for glucose testing after a failed 1 hour?
3 hours 100 gram challenge
What are the parameters for 100 g 3 hour test?
-fasting
-1 hr
-2 hr
-3 hr
fasting > 95
1 hr > 180
2 hr > 155
3 hr > 140
How many parameters must you fail in the 3 hour to be diagnosed with GDM?
2
How do you target underlying type II diabetes
-HbA1C > 5.7%
-GDM previous pregnancy
-Hx cardiovascular disease
-Htn
-HDL<35 Triglyceride >250
-PCOS
-First degree relative, physical inactivity, high risk ethnic group
Pregnancy risks with gestational diabetes
-LGA
-Macrosomia (>4500 mg)
-increased risk operative delivery
-shoulder dystocia
-brachial plexus injury
-increased risk C/S
What occurs when the mothers blood brings extra glucose to the fetus?
-fetus makes more insulin to handle excess sugar
-extra glucose gest stored as fat and fetus becomes larger than normal
What are risks to the birthing mom with GDM?
-hypertension
-preeclampsia
-birth trauma
What are the risks to the baby? (metabolic complications)
-hypoglycemia
-hypocalcemia
-hyperbilirubinemia
How do you treat GDM? First line
-Personalized meal plan (35-40% carbs, 20% protein, 40% fat)
-moderate exercise
-nutritional consult
If unable to get GDM in control with lifestyle modifications then step 2:
-insulin
Blood glucose monitoring goals
-fasting
-postprandial (1 and 2 hr)
fasting <95
1 hr <140
2 hr <120
What is A1 GDM? A2?
A1: able to be controlled with diet & exercise
A2: medication involved
A2 prenatal care plan
Antenatal testing? Delivery suggestions?
-weekly antenatal testing begins at 32 weeks
-deliver 39-40 weeks
-consider C/S if estimated fetal weight (EFW) is > 4,500 grams
Postnatal care?
-testing
Perform the 75 gram f2 hr oral glucose challenge at 6 weeks postpartum
-Diabetes screening annual for 5-10 years
What is the risk of future DM in a pt that had GDM?
50-70% increased risk
What can increase the risk of recurrence of GDM?
A Short interval - encourage contraception!
