DM in Pregnancy Flashcards
What is the current thinking behind gestational DM?
May be an already overlying DM that is only picked up in pregnancy (or exacerbated by it)
What is the white classification system of DM in pregnancy?
Old classification of DM that is no longer used in practice, but still in some research settings
What is the most common medical complication in pregnancy?
DM
In what ethnicities is the prevalence of gestational DM the highest?
Hispanics
Asians
Blacks
What are the three ways to diagnose DM?
- Random over 200
- Fasting over 126
- HbA1C more than 6.5%
How do you diagnose gestational DM? What indicates a positive test?
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
What indicates a positive 100 g, 3 hour glucose tolerance test?
If 2 or more blood draws over the 3 hour period, then positive
When in gestation does a mother undergo the glucose tolerance test?
Between 24-28 weeks
What happens if only one of the values of the 100g 3 hr glucose tolerance test is abnormal?
May have increased complications, despite not having true gestational DM
A BMI over what value is a risk factor for gestational DM?
30
What are the two conditions that may predispose to GDM?
- Prediabetes
- PCOS
True or false: if a mother has GDM in a previous pregnancy, she will likely get it again with the next pregnancy
True
Women over what age have a risk for developing GDM?
35
How can you differentiate between GDM, and underlying DM?
GDM does not occur until late in the pregnancy–thus if test is positive early, more likely to be underlying DM
What is the 1 step OTT? When is this performed? What indicates a positive result?
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
What is the “goal” of the maternal body early on in the pregnancy?
accumulate fat for when the fetus grows in the later stages, since this is when most growth occurs
What happens to insulin sensitivity early on in the pregnancy? Late?
Increased sensitivity early on to store fat.
Decreases later
When in pregnancy does insulin resistance begin to increase?
15-20 weeks
How often should you f/u with GDM pts? Why?
Weekly, since insulin needs vary so much
What is the main hormone that influences GDM?
Human placental lactogen
What is adiponectin, and what is its role in GDM?
Protein synthesized by adipocytes that increases insulin sensitivity.
Decreases with GDM
True or false: nearly every pregnancy complication has an increased chance with GDM
true
Who is at risk for stillborns: GDM or prediabetics?
Prediabetics
When in the pregnancy is GDM particularly bad on the fetus? Why?
First trimester, since this is when organogenesis is largely occurring
