DM of Pregnancy Flashcards
When postpartum screening?
GDM postpartum 4-12wks
fetal assessment indicated in pregnancies complicated by gestational diabetes mellitus
- Antenatal fetal testing in women with poorly controlled or medication-requiring GDM without other morbidities usually is initiated at 32 weeks of gestation.
- scheduled cesarean delivery when the estimated fetal weight is 4,500 g or more
- Women with GDM with good glycemic control and no other complications are commonly managed expectantly until term.
What’s the 1st Management of GDM?
•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 ))
Steps of management of GDM
- 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 )) - when target glucose levels cannot
(( Insulin )) historically has been
Pt. On diet with GDM you will follow her at least
Monthly
If pt not responding to diet in GDM ?
Start insulin.
Diagnosis GDM
Fasting > 95
1hr > 180
2hr >155
3hr>140
>=2 abnormal value (GDM )
1 abnormal value ( preDM or impaired DM )
GDM screening?
all pt. 24-28 wks by OGT.
GDM Maternal and Fetal Complications 10.
- preeclampsia
- cesarean delivery
- diabetes (predominantly type 2 diabetes) later in life
- risk of macrosomia.
- neonatal hypoglycemia.
- hyperbilirubinemia.
- shoulder dystocia
- birth trauma.
- stillbirth
- adult-onset obesity and diabetes in offspring.
GDM Risk Factors 8
- age>25y
- BMI > 25
- previous GDM
- Family hx of DM in 1st degree relative
- previous macrocosmic baby
- polyhydramnios
- large for date baby in current pregnancy
- previous unexplained stillbirth
Obstetric Complications preGDM 8
• *primary cesarean delivery
• *Spontaneous preterm labor
• *polyhydramnios
• *Preeclampsia
• *hypertensive disorders
• *uteroplacental insufficiency
• *iatrogenic preterm birth
• *stillbirth
The neonatal consequences of poorly controlled pregestational diabetes:
profound hypoglycemia
• *respiratory distress syndrome
• *polycythemia •
*organomegaly
• *electrolyte disturbances
• *hyperbilirubinemia
• Long-term outcomes for offspring: *obesity and carbohydrate intolerance + HTN
Preexisting Perinatal Morbidity and Mortality (( complication ))
• *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
Preexisting Maternal (( complication))
• *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
Preexisting Antepartum management
• Antepartum fetal monitoring, including the nonstress test, the biophysical profile (usually once or
twice per week)