Exam 1 - Concurrent Disorders of Pregnancy Flashcards
Exam 1
baby’s head is large for their gestational age
Macrosomia
when babies get stuck in the birth canal
Shoulder distocia
What are the neonatal risks of a Mom with preexisting diabetes?
(1) Neonatal hypoglycemia
(2) Neonatal hypocalcemia
(3) Neonatal hyperbilirubinemia
(4) Respiratory distress syndrome
(5) T2D for baby later in life
What makes pregnancy a naturally diabetogenic state?
Hyperinsulinemia
Hyperglycemia
Mild fasting hypoglycemia
What is responsible for creating resistance to insulin in maternal cells in late pregnancy?
Estrogen, progesterone, and hPL
Why does fetuses get hyperglycemia and hyperinsulinemia?
b/c glucose easily crosses the placenta, but insulin does NOT
Risk factors for GDM
(1) Overweight (BMI 25-29), obese (BMI > 30)
(2) Pregnant person over 25 yo
(3) Previous birth outcome with GDM association
(4) GDM in previous pregnancy
(5) H/o abnormal glucose intolerance
(6) Hx of diabetes in close relative
(7) Part of high-risk ethnic group
What is the standard of care for screening for GDM?
24-28 weeks
The first glucose test is what?
Glucose challenge test (GCT)
What is the second glucose test?
Oral glucose tolerance test (OGTT)
3-hour, 100g load describes which glucose test?
Oral glucose tolerance test (OGTT)
1-hour, 50g load describes which glucose test?
Glucose challenge test (GCT)
How is GDM diagnosed?
OGTT values should show at least 2 abnormal values (elevated)
Symptoms of GDM
Increased thirst
Needing to urinate more frequently
Nausea
Dry mouth
Tiredness
Blurred vision
Name 3 risks of GDM for the pregnant person
Higher risk of preeclampsia
Higher risk of cesarean delivery
Increased risk of T2D later in life
Name at least 3 risks of GDM for the fetus/neonate
(1) Macrosomia
(2) Neonatal hypoglycemia
(3) Hyperbilirubinemia
(4) Shoulder dystocia
(5) Birth trauma
The biggest thing we can do to help people with GDM have a healthy pregnancy is….
management of blood sugars through diet and exercise
How should pregnant people with GDM manage their sugars?
Take blood sugars at home and track
Fasting blood sugar target should be:
<95 mg/dL
1-hr postprandial sugar target should be:
<=140 mg/dL
2-hr postprandial sugar target should be:
<=120 mg/dL
____ is the first line pharmacologic therapy for GDM
insulin
During labor and birth process, blood glucose is monitored hourly to maintain levels at ____ to ____ mg/dL
80-110 mg/dL
T/F: Most pts with GDM return to normal glucose levels after birth
True
Patients who have had GDM have up to a __% chance of developing T2D later in life!
70
Name one long-term implication of GDM for baby
Increased risk of childhood / adult obesity
3 types of anemia
(1) Iron-deficiency anemia
(2) Sickle cell disease
(3) Thalassemias
____ is the most common hematologic abnormality
Anemia
Blood d/o that occurs when the body doesn’t have enough iron to produce healthy RBCs
Iron-deficiency anemia (IDA)
To properly diagnose IDA, what do we measure?
Hb level and ideally ferritin
Risk factors for IDA include…
(1) poor diet
(2) GI disease
(3) Short interval b/w pregnancies
IDA is associated with increased risk of what 3 things?
(1) Low-birth weight
(2) Preterm delivery
(3) Perinatal mortality
Nursing care for IDA include…
(1) Identify abnormal lab values (Hb < 11 g/dL)
(2) Management of low iron w/ supplements/food
What is a low Hb level that is considered anemic in pregnancy?
Hb < 11 g/dL
What is the supplement for IDA?
Ferrous sulfate 325 mg BID
Side effects of ferrous sulfate include what 3 things?
(1) constipation
(2) GI upset
(3) poor absorption
What can increase absorption of ferrous sulfate?
Vitamin C
What can decrease absorption of ferrous sulfate?
Calcium - avoid taking with milk products, etc.
Name at least 3 examples of iron-rich foods.
(1) green, leafy veg
(2) meats
(3) nuts
(4) beans
(5) legumes
A group of autosomal recessive disorders involving abnormal Hg (HgS)
Sickle Cell Disease
Spectrum of disorders characterized by reduced synthesis of globin chains, leading to microcytic anemia
Thalassemia
