DM of Pregnancy Flashcards

1
Q

When postpartum screening?

A

GDM postpartum 4-12wks

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2
Q

fetal assessment indicated in pregnancies complicated by gestational diabetes mellitus

A
  1. Antenatal fetal testing in women with poorly controlled or medication-requiring GDM without other morbidities usually is initiated at 32 weeks of gestation.
  2. scheduled cesarean delivery when the estimated fetal weight is 4,500 g or more
  3. Women with GDM with good glycemic control and no other complications are commonly managed expectantly until term.
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3
Q

What’s the 1st Management of GDM?

A

•dietary modifcations, exercise, and glucose monitoring:

((fasting or preprandial blood glucose values be below 95 mg/dL ))
((postprandial blood glucose values be below 140 mg/dL at 1 hour))
(( 120 mg/dL at 2 hours ))

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4
Q

Steps of management of GDM

A
  1. begins by :dietary modifcations, exercise, and glucose
    monitoring:
    (( fasting or preprandial blood glucose values be below 95 mg/dL ))
    (( postprandial blood glucose values be below 140 mg/dL at 1 hour ))
    (( 120 mg/dL at 2 hours ))
  2. when target glucose levels cannot
    (( Insulin )) historically has been
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5
Q

Pt. On diet with GDM you will follow her at least

A

Monthly

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6
Q

If pt not responding to diet in GDM ?

A

Start insulin.

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7
Q

Diagnosis GDM

A

Fasting > 95
1hr > 180
2hr >155
3hr>140
>=2 abnormal value (GDM )
1 abnormal value ( preDM or impaired DM )

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8
Q

GDM screening?

A

all pt. 24-28 wks by OGT.

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9
Q

GDM Maternal and Fetal Complications 10.

A
  1. preeclampsia
  2. cesarean delivery
  3. diabetes (predominantly type 2 diabetes) later in life
  4. risk of macrosomia.
  5. neonatal hypoglycemia.
  6. hyperbilirubinemia.
  7. shoulder dystocia
  8. birth trauma.
  9. stillbirth
  10. adult-onset obesity and diabetes in offspring.
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10
Q

GDM Risk Factors 8

A
  1. age>25y
  2. BMI > 25
  3. previous GDM
  4. Family hx of DM in 1st degree relative
  5. previous macrocosmic baby
  6. polyhydramnios
  7. large for date baby in current pregnancy
  8. previous unexplained stillbirth
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11
Q

Obstetric Complications preGDM 8

A

• *primary cesarean delivery
• *Spontaneous preterm labor
• *polyhydramnios
• *Preeclampsia
• *hypertensive disorders
• *uteroplacental insufficiency
• *iatrogenic preterm birth
• *stillbirth

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12
Q

The neonatal consequences of poorly controlled pregestational diabetes:

A

profound hypoglycemia
• *respiratory distress syndrome
• *polycythemia •
*organomegaly
• *electrolyte disturbances
• *hyperbilirubinemia
• Long-term outcomes for offspring: *obesity and carbohydrate intolerance + HTN

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13
Q

Preexisting Perinatal Morbidity and Mortality (( complication ))

A

• *Major congenital anomalies occur in 6–12% of infants
• *spontaneous abortion
• *Complex cardiac defects
central nervous system anomalies, such as anencephaly and spina bifida
skeletal malformations, including sacral agenesis
• *Stillbirths
• *risk of shoulder dystocia
• *Fetal macrosomia

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14
Q

Preexisting Maternal (( complication))

A

• *retinopathy and nephropathy = eye examination + RFT + urinary protein excretion in the 1st T
• *Chronic hypertension
• *Acute myocardial infarction
• *Gastroparesis increases the risk of hypoglycemic episodes
• *Diabetic ketoacidosis
• *increase risk of infection eg vaginal candidiasis, UTI, endometrial or wound infection

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15
Q

Preexisting Antepartum management

A

• Antepartum fetal monitoring, including the nonstress test, the biophysical profile (usually once or
twice per week)

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16
Q

gestational diabetes lead to type 1 or type 2 ?

A

more than one half of these women develop type 2 diabetes

17
Q

What’s the most common type of DM in pregnancy?

A

GDM resolve after delivery.

18
Q

Preexisting GDM diagnostic criteria?

A

• .in the 1st trimester or early 2nd trimester with the standard diagnostic
criteria of :
1- hemoglobin A 1 C (HbA 1 C ) of 6.5% or greater
2. • - fasting plasma glucose of 126 mg/dL or greater
3.• 2-hour glucose of 200 mg/dL or greater on a 75-g oral glucose
tolerance test

19
Q

Preexisting GDM Management?بالترتيب

A
  1. Maternal glucose control should be maintained near physiologic levels before and throughout pregnancy
  2. Self-monitoring of blood glucose
  3. carbohydrate-controlled diet
  4. ( Fasting 95 mg/dL ) (1-hour postprandial levels of 140 mg/dL ) ( 2-hour postprandial values of 120 mg/dL )
  5. Insulin requirements will increase throughout pregnancy, most markedly in the period between 28 weeks and 32 weeks of gestation
  6. check urine ketones when their glucose levels exceed 200 mg/dL
  7. 400 micrograms of folic acid
  8. conversion to a subcutaneous insulin pump before pregnancy may
    improve glycemic control, particularly in those with type 1 diabetes
  9. oral antidiabetic medications are not approved by the FDA for treatment of diabetes during pregnancy (( insulin best ))
  10. Women with well-controlled diabetes with no other comorbidities may be managed expectantly to 39 0/7 weeks to 39 6/7 weeks of gestation
    as long as antenatal test is reassuring
  11. Early delivery (36 0/7 weeks to 38 6/7 weeks of gestation, or even
    earlier) may be indicated in some patients with vasculopathy,
    nephropathy, poor glucose control, or a prior stillbirth
  12. 4.5 kg > CS
  13. low-dose aspirin (81 mg/day) prophylaxis ((12 weeks and 28 weeks ))
  14. Breastfeeding encouraged. + increase 500 Kcal more than the prepregnancy caloric intake.
20
Q

What’s the character of the normal pregnancy?

A
  1. mild fasting hypoglycemia.
  2. Postprandial hyperglycemia
  3. Hyperinsulinemia.
21
Q

Human placenta lactogen
Produce from what?
What’s the action?

A
  1. Produced by syncytiotrophoblasts of placenta.
  2. Acts to promote lipolysis ➔ increased FFA and to decrease maternal glucose uptake and gluconeogenesis. “Anti-insulin”
22
Q

Interfere with insulin-glucose relationship.

A

Estrogen and Progesterone

23
Q

Placental product that may play a minor role.

A

Insulinase enzyme

24
Q

Insuline secretion

A

•Increase during pregnancy
• Insuline resistance is maximum at 24-28 weeks
• Fetus start to secreting insulin by 12 weeks