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)
gestational diabetes lead to type 1 or type 2 ?
more than one half of these women develop type 2 diabetes
What’s the most common type of DM in pregnancy?
GDM resolve after delivery.
Preexisting GDM diagnostic criteria?
• .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
Preexisting GDM Management?بالترتيب
- Maternal glucose control should be maintained near physiologic levels before and throughout pregnancy
- Self-monitoring of blood glucose
- carbohydrate-controlled diet
- ( Fasting 95 mg/dL ) (1-hour postprandial levels of 140 mg/dL ) ( 2-hour postprandial values of 120 mg/dL )
- Insulin requirements will increase throughout pregnancy, most markedly in the period between 28 weeks and 32 weeks of gestation
- check urine ketones when their glucose levels exceed 200 mg/dL
- 400 micrograms of folic acid
- conversion to a subcutaneous insulin pump before pregnancy may
improve glycemic control, particularly in those with type 1 diabetes - oral antidiabetic medications are not approved by the FDA for treatment of diabetes during pregnancy (( insulin best ))
- 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 - 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 - 4.5 kg > CS
- low-dose aspirin (81 mg/day) prophylaxis ((12 weeks and 28 weeks ))
- Breastfeeding encouraged. + increase 500 Kcal more than the prepregnancy caloric intake.
What’s the character of the normal pregnancy?
- mild fasting hypoglycemia.
- Postprandial hyperglycemia
- Hyperinsulinemia.
Human placenta lactogen
Produce from what?
What’s the action?
- Produced by syncytiotrophoblasts of placenta.
- Acts to promote lipolysis ➔ increased FFA and to decrease maternal glucose uptake and gluconeogenesis. “Anti-insulin”
Interfere with insulin-glucose relationship.
Estrogen and Progesterone
Placental product that may play a minor role.
Insulinase enzyme
Insuline secretion
•Increase during pregnancy
• Insuline resistance is maximum at 24-28 weeks
• Fetus start to secreting insulin by 12 weeks
