Diabetes in pregnancy Flashcards
What is the difference between pregestational diabetes and gestational diabetes?
pregestational is when the mother has diabetes BEFORE getting pregnant
gestational is when the mother develops diabetes DURING pregnancy
What are the risk factors for GDM?
35y + high risk group: arab, african american, hispanic, south asian, asian family history of diabetes obesity given birth to a baby over 4kg PCOs having prediabetes being on corticosteroid meds GDM in previous pregnancy
What is the best way to prevent GDM?
diet-based intervention > PA > metformin
Explain what happens to insulin resistance during pregnancy.
it is normal that during the second trimester, insulin resistance happens, so that the fetus can receive more CHO, and the mother then uses fat for energy. In the 3rd trimester, insulin resistance goes down by 50%
What are the 4 phases in pre and gestational DM?
1. preGDM: preconception counselling GDM: prevention, screening, diagnosis 2. management during pregnancy 3. management in labour 4. postpartum considerations
What happens to the baby if the mother her dysglycemia (high BG) in the 1st and 2+3rd trimester?
1: fetal malformations
2+3: macrosomia + metabolic complications
What is the checklist for preconception for women with pregestational diabetes? (4 things)
- preconception A1C of <7%
- can remain on metformin or glyburide
- folic acid 1mg/d for 3 months prior to conception
- discontinue: ACEi, ARB, statin
What is the pregnancy management for pre-existing T1 and T2 diabetes?
T1DM: basal-bolus insulin therapy
T2DM: switch to insulin
What are the target BG for SMBG? (both preGDM and GDM)
FBG and PPG: <5.3
1h PPG: <7.8
2h PPG: <6.7
What is the recommended total weight gain in kg and lbs?
BMI<18.5: 12.5-18 & 28-40
BMI 18.5-24.9: 11.5-16 & 25-35
BMI 25-29.9: 7-11.5 & 15-23
BMI >30: 5-9 & 11-20
When is the universal screening for GDM?
at 24-28 weeks
What is the screening process for women at high risk of GDM?
check A1C in 1st trimester: if >6.5% or FPG>7 -> treat like T2DM
then confirm diagnosis post partum with OGTT
What is the preferred test for GDM diagnosis? (give cut offs)
50g CHO is given if <7.8 -> no diabetes if 7.8-11 -> come back for OGTT with 75g CHO FBG: <5.3 1h: <10.6 2h: <9 if >11 -> GDM
What is the first line treatment for GDM?
insulin
What is the nutrition therapy (intervention) for women with GDM?
moderate carb diet with low GI foods
3 meals a day with 2 or more snacks
breakfast: 15-30g CHO
lunch + supper: 30-45g CHO
