Diabetes in Pregnancy Flashcards
1. Describe the maternal and fetal complications associated with pregestational diabetes. 2. Describe the maternal and fetal complications associated with gestational diabetes. 3. Be aware that DKA can occur with lower blood sugars and more rapidly in pregnancy. 4. List the differences in the pathophysiology and clinical manifestations of pregestational versus gestational diabetes.
What blood sugar in pregnant women should start worrying about DKA?
200
How does DKA present vs HHS?
DKA is more fatigue/LETHARGY and urinating a ton.
HHS is more abdominal pain with urinating a lot.
What tends to be abnormal in DKA?
-Pt has an anion gap metabolic acidosis. (A)
-Pt has elevated blood sugars. (D)
-Pt has ketones. (K)
How do we treat pts with DKA?
-Treat with isotonic saline immediately, to correct acidosis.
-Give insulin once blood sugars and anion gap obtained.
-Consider giving 5% dextrose once starting to reach blood sugar target, to prevent hypoglycemia.
-Correct any electrolyte abnormality (hypokalemia) - in every pt.
If a pt with DKA has apparent hyperkalemia, what do we do?
What about if they have a normal amount of K+?
It is probably a false hyperkalemia because the acidosis pulls out the K+ from the cells.
At any rate, give the pt K+ at a rate of 20 mEq/hr once they start having urinary output.
If normal K+, you can give them K+ immediately.
*All DKA pts will be hypokalemic.
If a mother with DKA has recurrent late decelerations with minimal variability, what should we not do?
Do not delivery the baby till because the acidosis is from the mother.
How do you calculate an anion gap?
Na - (Cl-+ HCO3-)
Why is it easy for women to develop diabetes mellitus during pregnancy?
Their placentas release many hormones that cause insulin resistance (human placental lactogen hormone and Progesterone).
For diabetic retinopathy, what happens during pregnancy?
It is accelerated.
What does pregestational diabetes do for hypertensive diseases?
It worsens them - gestational hypertension and preeclampsia.
Why do diabetic pts experience higher rates of preterm delivery?
Their diabetes worsens the hypertensive diseases which promote preterm delivery.
For pregestational diabetes, what are the main risks for the baby and mom?
-Early fetal loss
-still birth
-fetal anomalies (VSD/cardiac, skeletal, neural tube defects)
-IUGR
-macrosomia
-Gestational hypertension
-Preeclampsia
-Preterm delivery
-Cesarean delivery
What is the way to diagnose diabetes in a pregnant woman?
What weeks of pregnancy?
-A 2-step method: 50 g 1 hour glucose test. After, we do a 3 hour 100 g glucose test.
-24-28 weeks of gestation.
What are the cutoffs for diabetes when diagnosing it in pregnant women?
50 gm glucose test
-Under 105 fasting
-Under 140 1 hour after 50 g
100g glucose test
-Fasting, under 105
-1 hour, under 180
2 hour, under 155
3 hour, under 140
When should we perform a cesaren section on a diabetic woman?
If her estimated fetal weight is 4500 g or more.
For a woman with diabetes before pregnancy, what is her goal A1c before she can be off contraception and try for a baby?
A1C under 7%
With a HA1C 10% or more, what is the likelihood of a fetal anomaly?
25% or more.
What antihypertensive medication should be discontinued during pregnancy?
ACE inhibitors because they cause fetal anomalies.
What pH should we start suspecting DKA in a mother?
pH under 7.35.
What should happen post partum for all mothers with GDM?
Have them undergo a 75 g 2 hour glucose test at 6 weeks post partum.
Aside from the 2 step GDM diagnostic tests, what is also acceptable, according to the IADPSG?
A one step 75 g 2 hour glucose test. Not widely accepted in the states though.
What are benefits of breast-feeding in a GDM mother?
How about benefits in baby?
-Loss of weight in mother. Decrease the risk of developing T2DM later in life.
-Prevent diabetes in baby later on. Prevents obesity in childhood.
