Diabetes in pregnancy

Question 1

definition: gestational diabetes

Answer 1

diabetes diagnosed, or first recognized, in pregnancy

“diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes”

Question 2

criteria for diagnosing DM

Answer 2

• fasting plasma glucose over 126 mg/dL
• 2h plasma glucose 200 mg/dL or greater following 75gm OGTT
• HgA1C over 6.5%
• random plasma glucose 200 mg/dL or greater

Question 3

when is screening for gestational diabetes done?

Answer 3

24-28 weeks

Question 4

what is the two step strategy for diagnosing gestational diabetes?

Answer 4

step 1: one hour 50 gram glucose challenge

step 2: if over 135, diagnostic 100 gram OGTT

Question 5

what are the factors that warrant earlier screening for gestational diabetes?

Answer 5

• gestational DM in previous pregnancy
• known impaired glucose tolerance
• BMI over 30

Question 6

what is the insulin sensitivity level in early pregnancy? late pregnancy?

Answer 6

• early: normal or increased

- late: decreased 50-60%

Question 7

what are the pathophysiological steps of GDM?

Answer 7

• increased insulin resistance
• increased insulin secretion
• adequate in the first trimester
• inadequate as gestation progresses
• inadequate insulin secretion
• hyperglycemia

Question 8

what is adiponectin? how is it related to insulin resistance?

Answer 8

• endogenous insulin sensitizer made exclusively by adipocytes
• levels decrease through pregnancy in all women, but exaggerated decline in GDM - leads to insulin resistance

Question 9

miscarriage rates in gestational diabetics is linked to levels of what marker?

Answer 9

HgA1c

Question 10

what is the Barker hypothesis?

Answer 10

changes in programming of fetus that have profound impact on that person’s life

Question 11

what are the neonatal complications of GDM?

Answer 11

• macrocomia
• fetal overgrowth
• asymmetric growth: shoulder dystocia
• surfactant deficiency: respiratory distress syndrome
• polycythemia and hyperviscosity
• hypertrophic and congestive cariomyopathy

Question 12

preconceptional care for DM has what effects on:

• HgA1c
• malformations
• PTB
• perinatal mortality

Answer 12

• lowers HgA1c
• decreases malformations
• decreases PTB
• decreases perinatal mortality

Question 13

what is the goal in the management of DM in pregnancy?

Answer 13

minimize postnatal sequelae of macrosomia, shoulder dystocia, neonatal hyperglycemia

Question 14

what are the cornerstones of therapy for both progestational and gestational DM?

Answer 14

diet and exercise

Question 15

what medication is used for gestational diabetics who do not respond to diet and exercise?

Answer 15

glyburide