Diabetes in Pregnancy

Question 1

1st Trimester

Answer 1

Decrese need for Insulin
1. In 10th wk of gestation the fetus begins to secrete its own insulin
2. maternal glucose rise, fetal increases

Increase glucose, increased circulating insulin, women in IDDM prone to hypoglycemia

Question 2

2nd Trimester

Answer 2

Increase need for Insulin

Question 3

3rd Trimester

Answer 3

Increase 2-3x needs for Insulin

Question 4

Type 1

Childhood IDM

Answer 4

Absolute insulin deficiency

Question 5

Type 2

Answer 5

Insulin Resistance (may be insulin dependent or diet controlled)

Question 6

Gestational DM

Answer 6

• Carbs intolerance
• All Pts screened
• GDM = > 20 -50% INCREASES of developing DM in the nest 5-10 yrs

Question 7

Risk to Birth in GDM

Answer 7

• Miscarriages
• Preterm Labor
• Big Baby > 4500g
• IGUR
• Infections
• Shoulder Dystocia
• Polyhydraminos
• Preterm ROM
• PPH
• Stillbirth
• C/S

Question 8

Fetus Risks

Answer 8

Congential malformations, Big Baby,
IUGR (Placental Insuff.), Myelomeningocele

Question 9

Key !!!

Answer 9

Stablize Maternal Glucose
* 1st trimester hyperglycemia 4-8x more likely to have baby with malformation

Care: Start w/ diet + exercise, glyburide + metformin okay, freg checks

Question 10

Plan of Care for GDM

Answer 10

START W/ DIET & EXERCISE
Controlled sugars = no increase risk
Daily Kick Count
NST
if hypoglycemic meds needed (can use oral agent (glyburide) or insulin subq

Question 11

Interventions

Answer 11

Diet, Exercise, Insulin ( monitor glucose, urine), Recogninzing complications req hospitalization, accurately determine EDC

Question 12

EDC and Mode of Birth

Answer 12

Common to electively induce the pregnancy at 38.5 - 40 wk
Amino to determine fetal lung maturity
L/S rate is 30-80%
Usually scheduled delivery for IDDM, so long-acting insulin may be D/C and sliding scale insulin begins

Question 13

During Labor

Answer 13

Contin fetal monitoring
IV hydration
Contin insulin drip
Carefully assess progress of labor

Question 14

Postpartum DM

Answer 14

Insulin need plummet w/ the birth of the placenta (sliding scale)
BIRTH CONTROL
Baby goes to the NICU for observation

Question 15

Group B Strep

Answer 15

Normal bacteria colonized in gut
All prego women screened at 36 wks
If +GBS ( or unknown status) :
* treat with IV abx x2 once ROM occurs
* Need to have 2 doses q4hrs b/4 delivery

May lead to infant pneumonia, sepsis, encephalitis , death
+GBS with one pregn does not mean +GBS with subsequent prego….. test each prego

Zynomycin ?

Question 16

Zika Virus

Answer 16

Source: Aedes Mosquito
Risk: Microcephaly in fetus of preg women
Plan of care: monitor with US
Vaccine: None ( at least 2yrs away)
Prevention: avoid travel if preg

Warm southern states
Dusk