Diabetes in Pregnancy Flashcards
target for A1C in pregnancy
less than 6% without hypoglycemia
limitation about A1C in pregnancy
normal dilution of hemoglobin in pregnancy affects reliability of A1C
what types of insulin have been best studied in pregnancy
Regular insulin; aspart, lispro, NPH and determir (but no insulin types have been shown to cross the placenta; the other types are just less studied)
rates of insulin amount in each trimester
0.7U/Kg in 1st trimester; 0.8U/Kg in 2nd trimester; 0.9-1 U/kg in 3rd trimester
pattern of insulin requirements throughout pregnancy
-12 weeks: requires less insulin than at baseline
-20 weeks: insulin requirements back to insulin requirements before pregnancy
-24 weeks: insulin requirements above baseline
-weeks after birth insulin requirements below pre-pregnancy requirements
glycemic targets in pregnancy
fasting glucose: 70-95/ <90
1 hour postprandial glucose: 110-140/ <140
2 hour postprandial glucose: 100-120/ <120
agents besides insulin that can be used in pregnancy
Metformin and Glyburide
sulfonylureas in pregnancy
-glyburide best studies
-crosses placenta
-neonatal hypoglycemia, macrosomia
-failed non-inferiority to insulin in RCT
TIR range and goals
TIR range: 63-140 (>70% in range)
TAR range: >140 (<25% is goal)
low range: 63-54 (<4% goal)
very low: <54 (<1% goal)
goals of monitoring CGM in pregnancy
-TIR>70% (63-140 AND achieving fasting BG<95 and 2 hour post-prandial <120
screening for retinopathy in pregnancy
-screen pre-pregnancy and first trimester; every trimester as per optho
aspirin use in pregnnacy
ASA is used in patients with pre-existing DM starting week 12 (may need >100mg)
when to test patients with GDM for DM screening postpartum
OGTT 4-12 weeks postpartum
