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OB > Exam 2- Diabetes Obesity Substance Abuse > Flashcards

Exam 2- Diabetes Obesity Substance Abuse Flashcards

1
Q

Patients with DM need what to start a safe pregnancy?

A
  • HBA1c less than 7%
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2
Q

a patient with DM and is pregnant is consider what?

A

A high risk pregnancy

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3
Q

what trimester is GDM usually diagnosed in pregnant women?

A

usually in the 2nd or 3rd trimester

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4
Q

Pregnancy is a diabetogenic state.. meaning?

A

meaning that pregnancy can cause diabetes

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5
Q

What can a pt with GDM do to increase their good outcome in their pregnancy?

A

Well managed diabetes can result in the same outcome as other pregnant women.
most important in pt w GDM

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6
Q

Current DM classification system with pregnancy

A
  • Pregestational diabetes
  • Type 1
  • Type 2:
  • Gestational diabetes
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7
Q

Pregestational diabetes

A

Pregestational diabetes – known prior to pregnancy

  • Type 1: Absolute insulin deficiency due toautoimmune
    beta cell destruction.
  • Type 2: Insulin resistance or deficiency due to a
    progressive loss of beta cell insulin secretion frequently on the background of insulin resistance.
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8
Q

Gestational diabetes

A

Gestational diabetes – diagnosed during
pregnancy
- any degree of glucose intolerance
with the onset or recognition during pregnancy.

  • Usually diagnosed in the second or third trimester of pregnancy (when the placenta is fully functioning and can release hormones that cause insulin resistance)
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9
Q

Gestational Diabetes-
pathophysiology

A

*Existence of pancreatic beta cell dysfunction
prior to pregnancy.

*Increased insulin resistance

  • Due to diabetogenic hormones secreted by the placenta:
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10
Q

Diabetogenic hormones secreted by the placenta:

A

*Growth hormone
*Human placental lactogen
*Progesterone
*Corticotropin releasing hormone

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11
Q

DM Complications in Pregnancy

A
  • Macrosomia
  • big baby + can cause birthing problems
    -risk of c/s
  • Birth trauma (shoulder dystocia)
  • Hypoglycemia
  • d/t N/V
  • Maternal complications included
    preeclampsia and cesarean birth.
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12
Q

Screening: in pts with GDM

A
  • Risk analysis of all pregnancies at 1st
    prenatal visit **
  • Additional screening again at 24-28 weeks gestation (glucose tolerance testing)
  • One or more abnormal values confirm a diagnosis of gestational diabetes.
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13
Q

Pregestational Diabetes: preconception counseling includes what?

A
  • Management of diabetes
  • HBA1c less than 7%
  • Identify and evaluate long-term
    complications
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14
Q

Pregestational Diabetes: Poor glycemic control leads to?

A
  • Birth defects
  • Macrosomia complications
  • Congenital malformations (renal, cardiac,
    skeletal, and CNS). These defects occur before 8 weeks gestation

**so preconception
counseling is crucial **
Have glucose management prior to pregnancy.

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15
Q

Care during pregnancy + main focus on ?

A
  • Nutritional management
  • Physical Activity
  • Pharmacologic Therapy

**Focus is on tight glucose control! **

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16
Q

Pharmacologic Therapy used when in GDM pts?

A

If nutrition and exercise is not adequate alone

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17
Q

Oral medications used as tx of GDM

A

*People tend to manage better with oral so standard of care may be changing to oral *

*Glyburide (DiaBeta) & Metformin
- both do not
cross the placenta and cause fetal and
neonatal hypoglycemia.

18
Q

ACOG still recommends what to be used as the first line therapy to control glucose levels?

A

insulin be used as a
first-line therapy to control glucose levels rather than oral agents.

19
Q

Insulin requires what interventions?

A
  • Frequent blood glucose measurements
    are necessary

-insulin dosage
adjusted on levels.

20
Q

Fetal well being screenings with a diabetic client

A

Fetal well being:
- NST (nonstress test)
- BPP
- Ultrasound for
size (of baby)

21
Q

Care of the diabetic client + birth plan

A

Determining the best time for birth (may
be need for medical induction of labor.

22
Q

Care of the diabetic client during labor

A
  • Monitor glucose levels every 1-2 hours
  • Maintain below 110 mg/dL
  • Insulin requirements d/t the drop after birth-
    hypoglycemia
23
Q

Care of the diabetic client after delivery

A
  • Glycemic abnormalities of GDM usually resolve.
  • Diagnosis of GDM puts women at risk for future type 2 diabetes. 50% increased risk
  • Future screening and prevention efforts
24
Q

Care of the diabetic client: education

A
  • Dietary changes
  • Glucose monitoring
  • Exercise
  • Medication
25
Q

Diabetic patient screenings for both mom and baby to be done throughout the pregnancy

A
  • Urine checks, kidney function, eye exams,
    HbA1c every 4-6 weeks
  • Fetal surveillance: Ultrasound (fetal
    growth, activity, amniotic fluid volume,
    BPP, NST
26
Q

Why does having GDM affect the baby’s size?

A
  1. the mother’s blood brings extra glucose to the fetus
  2. fetus then makes more insulin to handle extra glucose
  3. That extra glucose then gets stored as fat + fetus becomes larger than normal
27
Q

GDM Changing insulin needs with pregnancy: 1st trimester

A
  • insulin needs reduced; prone to hypoglycemia; N&V complicates situation
28
Q

GDM Changing insulin needs with pregnancy: 2nd trimester

A
  • increased needs;
    hyperglycemia leads to ketonemia;
    exaggerated ketones respond to caloric
    restriction
29
Q

GDM Changing insulin needs with pregnancy: 3rd trimester

A

marked increase of insulin needs; hyperglycemia leading to ketonemia

30
Q

GDM Changing insulin needs with pregnancy: labor + postpartum

A

decreased needs;
hypoglycemia

31
Q

Provider Management of the
Pre-gestational Diabetic Women

A
  • Referral to perinatologist
    and/or endocrinologist (high risk pregnancy specialists)
  • Regular visits with
    nutritionist
  • Hgb A1C every trimester
  • Fetal Echocardiogram
  • Level II ultrasound
  • Ophthalmologist
  • Baseline kidney and liver
    function tests with 24
    hour urine as indicated
  • Usual prenatal labs with
    thyroid panel
  • Adjust medications as
    needed
32
Q

Multidisciplinary approach of the
Pre-gestational Diabetic Women

A
  • Regular visits with
    nutritionist
  • Hgb A1C every trimester
  • Fetal Echocardiogram
  • Level II ultrasound
  • Ophthalmologist
  • Baseline kidney and liver function tests with 24 hour urine as indicated
  • Usual prenatal labs with thyroid panel
  • Adjust medications as needed
33
Q

Risks/complications of a diabetic pregnant client

A
  • Poor glycemic control leads to increased incidence of early pregnancy loss
  • Infections more common
  • Stillbirth significant risk
  • Congenital anomalies more common with
    diabetic pregnant women
    -Macrosomia occurs in 40-50% of all
    diabetic pregnancies
  • Poor glycemic control later in pregnancy leads to vascular disease
  • Polyhydramnios occurs 10 times more often
34
Q

Obesity defined as a BMI of ?

A

30 kg/m2 or more
high risk pt

35
Q

Underweight: BMI

A

Underweight: BMI<18.5

36
Q

Normal weight BMI

A

Normal weight: BMI=18.5-24.9

37
Q

Overweight BMI

A

Overweight: 25-29

38
Q

Severely obese
BMI

A

Severely obese:
BMI>40

39
Q

Risk w obesity

A
  • GDM
  • Hypertension
  • Thromboembolism
  • Preeclampsia
  • Preterm labor and birth
  • Fetal macrosomia
  • Depression
  • Fighting infection
  • Stillbirth
  • Cesarean birth
  • Early pregnancy loss
  • PP hemorrhage
  • Maternal mortality
  • Abnormal labor patterns-use of pitocin **
40
Q

Obese mothers more likely to
have what kind of births?

A

Augmentation of labor

Up to 3X higher rate of cesarean
- c/s: prolonged operation time,
increased blood loss, infection, DVT

41
Q

Commonly Abused
Substances

A
  • Alcohol-Fetal alcohol spectrum disorder (FASD)
  • Sedatives
  • Nicotine
  • Caffeine
  • Marijuana
  • Opiates and Narcotics (neonatal abstinence
    syndrome (NAS)
  • Methamphetamines
  • Cocaine
  • Prescription Drug Misuse

OB (8 decks)

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