Diabetes & pregnancy

Question 1

diagnosis of gestational diabetes

Answer 1

-fasting BG 126+
-A1C over 7%
-random glucose 200mg

Question 2

risk factors for gestational diabetes

Answer 2

-physical inactivity
-1st degree relative with diabetes/ hypertension
-high-risk race/ethnicity
-obesity
-PCOS
-hypercholesterolemia
-previous infant >9lbs
-smoker

Question 3

why would you check for gestational diabetes at the first prenatal visit?

Answer 3

if they have any risk factors for gestational diabetes

Question 4

when do you check for gestational diabetes without risk factors?

Answer 4

24-28 weeks

Question 5

what aren’t risk factors for gestational diabetes?

Answer 5

-no hx og glucose intolerance
-younger than 25 years old
-normal body weight
-no family history of diabetes (1st degree relatives)
-no hx of poor obstetric outcomes

Question 6

diagnosis of gestational diabetes

Answer 6

-fasting glucose over 95
-1 step OGTT 1 hour over 180
-2 hour over 153

Question 7

most common test for gestational diabetes

Answer 7

3 hour, needs to be less than 95

Question 8

patho of gestational diabetes

Answer 8

-deficiency or resistance to insulin
-insulin needs change throughout pregnancy
-insulin production cannot keep up with the latter part of pregnancy
-insulin resistance leads to postprandial hyperglycemia

Question 9

effects of GDM on pregnant person

Answer 9

-hydraminos
-gestational hypertension
-preeclampsia
-ketoacidosis
-preterm labor
-UTI
shoulder dystocia
-postpartum hemorrhage

Question 10

effects of GDM on fetus

Answer 10

-cord prolapse
-congenital defects
-macrosomia
-birth trauma
-preterm birth
-fetal asphyxia
-IUGR
-RDS
-polycythemia
-hyperbilirubinemia
-neonatal hypoglycemia
-childhood obesity

Question 11

therapeutic treatment for gestation diabetes

Answer 11

-improve metabolic control to reduce birth defects
-integrate the woman into management of her diabetes
-ensure contraceptive until stable glycemic is achieved

Question 12

first line of therapy for diabetes during gestation

Answer 12

insulin

Question 13

can metformin be taken if someone doesn’t want to use insulin?

Answer 13

yes

Question 14

fetal surveillance during GDM pregnancy

Answer 14

-ultrasounds
-fetal echo
-weekly NST after 20 weeks
-fetal kick count
-lung maturity
-PH

Question 15

maternal surveillance during GDM pregnancy

Answer 15

-office visit every 2 weeks up to 28 weeks then 2x per week till delivery
-urine checks at each visit
-kidney function test
-eye exam in 1st trimester
-a1c every 4-6 weeks

Question 16

management of GDM in labor

Answer 16

-IV saline or lactated ringers
-dex 50 at bed sides
-monitor glucose every 1-2 hours
-ideal to keep glucose under 110 throughout labor
-regular insulin iv if necessary
monitor I&O/VS every hour