Exam 2: Gestational Diabetes

Question 1

What is gestational diabetes

Answer 1

Glucose intolerance with onset during pregnancy usually in the second or third trimester

Question 2

Diagnosis of gestational diabetes (overt) at first prenatal visit

Answer 2

Fasting 126 mg/dL or above
HbA1c over 7%
Random glucose 200 mg/dL

Question 3

Risk factors for gestational diabetes

Answer 3

Physical Inactivity
First degree relative with diabetes hypertension
High-risk race/ethnicity
OBESITY
PCOS
Hypercholesterolemia
Previous large infant (> 9 lb)
Smoker
History of gestational DM, hydramnios, or family history of DM
S/S of glucose intolerance (polyuria, polyphagia, polydipsia, fatigue)

Question 4

When to test PT for gestational diabetes

Answer 4

24-28 if NO risk factors
First prenatal visit if they have risk factors

Question 5

Diagnosis criteria at 24-28 weeks for gestational diabetes

Answer 5

One or more abnormal OGTT values
Fasting BG over 95
1 step- 75g OGTT 1 hour over 180 mg/dL
75g OGTT 2 hour over 153 mg/dL

Question 6

What is the most common test done for gestational diabetes?

Answer 6

Three step test
Need to make sure PT is aware they will be at the appointment for 3 hours

Question 7

Pathophysiology of Gestational Diabetes

Answer 7

Deficiency or resistance to insulin
Insulin production cannot keep up with changing insulin needs during latter part of pregnancy
Results in postprandial hyperglycemia

Question 8

PTs with gestational diabetes cannot meet the demands for the ________ in insulin resulting in _______

Answer 8

INCREASE
Hyperglycemia

Question 9

Glucose in urine causes __________

Answer 9

Yeast infections

Question 10

Gestational diabetes effect on fetus

Answer 10

Larger babies (Macrosomia), worry about vaginal birth and shoulder dystocia

Question 11

Therapeutic management for pre-gestational diabetes

Answer 11

Improve metabolic control to reduce birth defects
Lifestyle modifications
Keeping a log

Question 12

Medications management for gestational diabetes

Answer 12

Insulin (first line therapy)
Oral hypoglycemic medications (second line)
These do not cross placenta

Question 13

Maternal surveillance during pregnancy for gestational diabetes

Answer 13

Office visits every 2 weeks until 28 weeks then twice weekly until delivery
Urine checks at each visit (looking for glucose or protein)
HbA1c every 4-6 weeks
Kidney function, eye test (1st tri)

Question 14

Fetal surveillance during pregnancy for gestational diabetes

Answer 14

Weekly NST after 28 weeks
Ultrasounds, fetal echo
Fetal kick counts
Lung maturity (LS ration 2:1)

Question 15

Dietary teaching for gestational diabetes

Answer 15

Avoid dieting
3 meals and 3 snacks per day
Small frequent meals throughout day
Bedtime snack with protein and fat

Question 16

Management of labor for PTs with gestational diabetes

Answer 16

IV normal saline or lactated ringers
50% dextrose syringe at bedside to treat hypoglycemia if on insulin
Monitor BG every 1-2 hours
Ideal: Glucose levels under 110 throughout labor

Question 17

Surveillance after birth (gestational diabetes)

Answer 17

Monitor newborn for hypoglycemia
Skin to skin
Keep newborn warm
Monitor BG every 2-4 hours for 48 hours
Encourage chest feeding

Question 18

Signs of hypoglycemia in newborn

Answer 18

Look for variations in heart rate (normal 110-160), jitters

Question 19

Normal blood glucose for newborns

Answer 19

BG over 40

Question 20

Education for gestational diabetes while pregnant

Answer 20

S/S of hypo/hyperglycemia
BG self-monitoring as directed
Drink 8-10 8oz glasses of water each day to prevent UTI
Wash hands frequently
Avoid simple sugars
Treatment: 8oz of milk and eat two crackers or take two glucose tablet

Question 21

Education for gestational diabetes upon discharge

Answer 21

Encourage lactation
Repeat GTT 6 weeks postpartum
Patients with GDM have a greater than 50% increased chance of developing type 2 diabetes
Reduce weight
Screen every 3 years after a normal screen

Question 22

When is gestational diabetes typically diagnosed?

Answer 22

Second or third trimester

Question 23

Can you identify pre-gestational diabetes vs. gestational?

Answer 23

Type 1: Absolute insulin deficiency
Type 2: Insulin resistance or deficiency primarily diagnosed in adults older than 30
Gestational diabetes: Glucose intolerance with onset during pregnancy usually in 2nd or 3rd trimester

Question 24

What are the possible complications of uncontrolled diabetes in pregnancy?

Answer 24

Macrosomia, birth trauma, electrolyte imbalances, and neonatal hypoglycemia

Question 25

What are the possible complications of diabetes during birth with the patient and after birth with the newborn?

Answer 25

Macrosomia could be dangerous for a vaginal delivery, causing shoulder dystocia

Question 26

What is the first line medication during pregnancy for GDM?

Answer 26

Insulin

Question 27

What follow up is necessary after delivery for the pregnancy patient?

Answer 27

Monitor newborn for hypoglycemia and monitor blood glucose every 2-4 hours for 48 hours