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OB/GYN > DM in Pregnancy > Flashcards

DM in Pregnancy Flashcards

1
Q

What is the current thinking behind gestational DM?

A

May be an already overlying DM that is only picked up in pregnancy (or exacerbated by it)

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2
Q

What is the white classification system of DM in pregnancy?

A

Old classification of DM that is no longer used in practice, but still in some research settings

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3
Q

What is the most common medical complication in pregnancy?

A

DM

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4
Q

In what ethnicities is the prevalence of gestational DM the highest?

A

Hispanics
Asians
Blacks

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5
Q

What are the three ways to diagnose DM?

A
  • Random over 200
  • Fasting over 126
  • HbA1C more than 6.5%
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6
Q

How do you diagnose gestational DM? What indicates a positive test?

A

Two step strategy:

  • one hour 50g glucose challenge.
  • If higher than 130, then proceed to 100g, 3 hour test, with a blood draw every hour
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7
Q

What indicates a positive 100 g, 3 hour glucose tolerance test?

A

If 2 or more blood draws over the 3 hour period, then positive

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8
Q

When in gestation does a mother undergo the glucose tolerance test?

A

Between 24-28 weeks

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9
Q

What happens if only one of the values of the 100g 3 hr glucose tolerance test is abnormal?

A

May have increased complications, despite not having true gestational DM

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10
Q

A BMI over what value is a risk factor for gestational DM?

A

30

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11
Q

What are the two conditions that may predispose to GDM?

A
  • Prediabetes

- PCOS

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12
Q

True or false: if a mother has GDM in a previous pregnancy, she will likely get it again with the next pregnancy

A

True

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13
Q

Women over what age have a risk for developing GDM?

A

35

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14
Q

How can you differentiate between GDM, and underlying DM?

A

GDM does not occur until late in the pregnancy–thus if test is positive early, more likely to be underlying DM

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15
Q

What is the 1 step OTT? When is this performed? What indicates a positive result?

A

75g of glucose performed at 24-28 weeks, and assessed 2 hours later.

If the first draw is higher than 180, or the 2 hour draw is higher than 153, then positive

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16
Q

What is the “goal” of the maternal body early on in the pregnancy?

A

accumulate fat for when the fetus grows in the later stages, since this is when most growth occurs

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17
Q

What happens to insulin sensitivity early on in the pregnancy? Late?

A

Increased sensitivity early on to store fat.

Decreases later

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18
Q

When in pregnancy does insulin resistance begin to increase?

A

15-20 weeks

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19
Q

How often should you f/u with GDM pts? Why?

A

Weekly, since insulin needs vary so much

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20
Q

What is the main hormone that influences GDM?

A

Human placental lactogen

21
Q

What is adiponectin, and what is its role in GDM?

A

Protein synthesized by adipocytes that increases insulin sensitivity.

Decreases with GDM

22
Q

True or false: nearly every pregnancy complication has an increased chance with GDM

A

true

23
Q

Who is at risk for stillborns: GDM or prediabetics?

A

Prediabetics

24
Q

When in the pregnancy is GDM particularly bad on the fetus? Why?

A

First trimester, since this is when organogenesis is largely occurring

25
Q

What is the relationship between vascular disease of GDM, and the risk of adverse fetal outcomes?

A

Positively correlated

26
Q

What is the equation for relative risk?

A

he ratio of the probability of an event occurring (for example, developing a disease, being injured) in an exposed group to the probability of the event occurring in a comparison, non-exposed group.

27
Q

What happens to the rate of malformations with increasing HbA1C at conception?

A

Increases

28
Q

What are the two factors that lead to the development of an overgrown fetus with GDM?

A

Hyperglycemia and hyperinsulinemia in utero

29
Q

What happens to neonatal BG levels when it is born? Why?

A

Drop d/t the loss of high BG levels of the mother, and oversecretion of insulin

30
Q

How do you measure C-peptide levels of the fetus?

A

Umbilical cord sampling

31
Q

What happens to the risk of the child born to a GDM mother of developing DM by adolescents?

A

6x

32
Q

What causes the heart defects in children born to GDM mothers?

A

Deposition of glycogen in the heart, causing hypertrophy

33
Q

What is the effect of hyperinsulinemia of the fetus on lung maturation?

A

Insulin inhibits surfactant production = increased risk of NRDS

34
Q

What causes the increase in the incidence of jaundice in children born to GDM mothers?

A

Polycythemia d/t hyperglycemia

35
Q

What, generally, were the results of the HAPO study?

A

Mothers who had only 1 abnormal reading on a OGTT–which is not a positive test– had an increase in fetal morbidity

36
Q

What percent of mothers who develop GDM will develop DM II over 10 years?

A

70%

37
Q

What is the average reduction of HbA1c with appropriate measures?

A

2.43%

38
Q

What is the rule of thumb when correlating HbA1C levels to average BG levels?

A

8% = 180 mg/dL

1% change is about 30 mg/dL

39
Q

Why is there an increase in shoulder dystocia with GDM?

A

Big baby coming out

40
Q

What is the recommended carb intake for GDM women?

A

Less than 50% of diet

41
Q

What is the main treatment for GDM?

A

Diet and exercise

42
Q

How do you treat GDM?

A
  • If on insulin, maintain tight control

- Continue oral hypoglycemia agents

43
Q

How many times should GDM mother monitor their BG levels?

A

4x/day

44
Q

What are the goal fasting and 2 hr postprandial BG levels for GDM mothers?

A
  • Fasting = less than 95

- 2 hr Postprandial = Less than 120 (1 hr less than 130)

45
Q

What are the three oral hypoglycemics that can be prescribed to a GDM mother?

A
  • glyburide
  • MEtformin
  • ACarbose and others
46
Q

When should you stop the pharmacotherapy for GDM? When should she follow up, and what should be done?

A
  • Stop postpartum

- 6-8 weeks f/u and do OGTT

47
Q

If the 6-8 week f/u OGTT is positive, then what? What if negative?

A 
Positive = new DM
Negative = repeat q 3 years
48
Q

What other lab value should be obtained for f/u postpartum GDM mothers?

A

TSH

OB/GYN (33 decks)

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