Dunn OB/GYN V Flashcards
society getting bigger
more risks for diabetes
american indian
higher risk of diabetes
pre-screening in obese pregnant women
prenatal labs
group B strep
ultrasound
HgA1c
> 4000g baby
LGA - large for gestational age
consider delivery if 37 weeks
HBA1c >6
diabetes uncontrolled
treatment for hyperglycemia in pregnant
insulin
metformin
glyburide
need to control glucose levels
diabetes in pregnancy
two types of patients
1922
insulin discovered
pre-gestational DM
mother has DM I or 2 before pregnant
chronic hyperglycemia
injury to all organ systems
class B
onset diabetes age 20 or older with duration less than 10 years
class C
onset diabetes at age 10-19 and duration of 10-19 years
class D
onset diabetes before age 10 and duration more than 20 years
class E
overt diabetes with calcified pelvic vessels
DM I
destruction of beta cells of pancreas
5-10% of all diabetes
1% diabetes in pregnancy
have baby that is very small
DM II
90-95% cases
insulin resistance and relative insulin deficiency
most managed - lifestyle mods, diet, exercise
diabetic pregnant
look at eyes, kidneys, neuropathies
get a HbA1c
malformation in infants of diabetic mothers
caudal regression spina bifida heart anomalies anal/rectal atresia situs inversus
gestational diabetes
during pregnancy
-first recognized when pregnant
caused by HPL - prevents body from using insulin
relative insulin resistance
long term risk fx for diabetes**
carbohydrate intolerance
pancreas cannot secrete enough insulin
-increases glucose
crosses placenta
-stored in fetus - excess fat
risk factors for GDM
increased maternal weight and age previous GDM previous macrosomic infant fam hx diabetes ethnic background - non-hispanic black, latino, american indian, pacific islander
US
8% population have diabetes
women over 20 - half of these individuals
only 25% aware they have disease
first trimester
decreased fasting blood glucose
insulin production and sensitivity increase
end of first trimester
decrease sensitivity
responding increase in insulin production
creates diabetogenic state of pregnancy
pregnant women
hepatic glucose production 1.3x higher than non-pregnant women
later in pregnancy
increased glucose levels
more hepatic production
late pregnancy
diabetogenic state
20-40 weeks
-increased hCS, PRL, cortisol
complication of uncontrolled diabetes in pregnancy
mother
HTN preeclampsia miscarriage worsening of diabetes in mother vasculopathy - fetal growth restriction ketoacidosis or severe hypoglycemia
baby complications uncontrolled diabetes in pregnancy
macrosomia hypoglycemia at birth** hyperbilirubin low Ca and Mg resp distress syndrome polycythemia hyperviscosity
increased risk for adult obesity**
increased risk fo DM II**
preterm labor
increased risk with GDM
vascular disease, HTN, obesity - all conribute to increased risk
pederson hypothesis
complications
maternal hyperglycemia
> fetal hyperglycemia
> fetal hyperinsulin
> excessive fetal growth
macrosomia - difficult delivery
poorly controlled diabetes
increased risk for resp distress in baby
screening for GDM
don’t need to do it on patient with diabetes - bc already have it
GDM screening
test at risk women earlier
average risk 24-28 weeks
GDM screening test
50g glucose challenge test
oral glucose tolerance test 75 or 100g
fasting plasma glucose 126
random plasma glucose 200
**both diagnostic - no further testing
indications for delivery with GDM
poorly controlled blood glucose abnormal fetal testing growth restriction deterioration of vascular complications significant macrosomia
indications for increased surveillance
macrosomia growth restriction look at amniotic fluid elevated A1C frequent admissions during pregnancy
intrapartum care for GDM
IV fluid therapy
-administer insulin
dextrose 5 drip
artificially control sugar intake and insulin**
goal blood glucose level
<110 to reduce hyperglycemia risk
DM I
need insulin
postpartum care for GDM
encourage patient to maintain blood glucose levels
promote bonding and lactation with newborn
educate patients
breastfeeding
insulin requirements lower
contraception
should address with patient during postpartum period
goal of tx for GDM
keep glucose in normal range
diet, exercise, daily monitoring of blood glucose, insulin, pharmacy
exercise
even type 1 DM
significant vasoconstriction - no exercise
