Diabetes in Pregnancy Flashcards
What is Gestational Diabetes?
Diabetes that is first diagnosed in Pregnancy
What is Tx for Gest Diabetes A1 vs A2?
A1: Diet
A2 Oral or insulin
What is the criteria for Diagnosis of DM?
Fasting Plasma Glu > 126
2hr plasma Glu > 200 on 75 gm OGTT
HgA1C >6.5
Radom Plasma Glucose > 200
What is included in the 2 step strategy of Dx of GDM?
Step 1: One hour 50 gm Glucose Challenge test. Non Fasting (>133 go to S2)
Step 2 : Diagnostic OGTT 100 g
Who is eligible for Early screening for GDM?
Gest Diabtes in previous preg
Known impaired glucose tolerance
Obesity- BMI > 30
>35 yo
What is the 1 tep strat for diagnosis?
75 g 2 hour OGTT performed at 24-28 weeks
What happens to Insulin sensitivity during pregnancy?
Same or Greater at first to store fat
Goes way down later
What is the pathophysiology of GDM?
Inc Insulin resistance => Inc Insulin secretion Adequate in 1st Tri Inadequate as gest progresses => Inadequate insulin sec => Hyperglycemia
What are the main reasons for insulin resistance in pregnancy?
Human Placental lactogen
What facotrs decrease insulin resistance in Pregnancy?
Adiponectin
What are the consequances of GDM?
Risk of all pregnancy complications increases Hypertension Preterm birth MAcrosomia Stillbirth Perinatal Death Malformation
What are the neonatal complications of Hyperglycemia
THickened myocardium 2/2 glycogen disposition
Delayed pulmonary maturity (ARDS)
WHati is the management for gestational diabetes?
Diet and exercise
Self monitoring glucose 4x day
Maint tight control
What are the oral Hypoglycemics used in GDM?
Glyburide (as effective as insulin)
Metformin
What is the Tx of GDM Postpartum?
Stop all Tx!
Test for thyroid function
