GDM

Question 1

What is GDM?

Answer 1

Glucose intolerance that is diagnosed in pregnancy.

Question 2

Pregnancy is what kind of state?

Answer 2

Pregnancy is an insulin resistant state so that we can increase nutrients to bb d/t GH, CRH and hPL

We will see increase in prolactin, progesterone and cortisol

Question 3

Risk factors for GDM

Answer 3

• 1. Overweight (BMI > 25) and
• 2. FH of. DB
• 3. High risk race/ethnicity (Hispanic)
• 4. Previous LGA bb (large gestational age)
• 5. HTN
• 6. PCOS (polycystic ovarian syndrome)
• 7. A1c > 5.7%
• 8. CVD
• 9. Previously GDM

Question 4

can we screen based on risk factors alone?

Answer 4

no. we will. miss 50%

Question 5

Screening plan:

Answer 5

2 step approach:

1. 1 hr glucola. (drink 50 Gms)

• Wait 1 hour to check B.S
  
  • Abnormal result: 130-140 mg/dl
  • If over 200 > don’t even do 3 hr screening -> go to diabetic education.
• If abnormal ->

2. 3 hour fasting gtt (glucose tolerance test)

• Check B.S every hour for 3 hours
  
  • Fasting: 95 mg/dl
  • 1 hour: 180 mg/dl
  • 2 hour: 155 mg/dl
  • 3 hour: 140 mg/dl
• 2 hours or more abnormal values= GDM

Question 6

other ways to screen for GDM

Answer 6

1. 2 hour glucose tolerance test. (75 gm load),
2. HgA1C
3. measure fasting glucose,
4. random glucose monitoring

Question 7

Main tx:

Answer 7

dietary change

excercise

Question 8

how to monitor glucose

Answer 8

Monitor daily: fasting and 1 or 2 hours post-prandial

1. HgA1C should be less than 8
2. Fasting: <95. Mg/dl
3. 1 hour: < 140mg/dl
4. 2 hour: <120 mg/dl
5. Glucose peaks at 90 minutes

Question 9

Tx: oral. hypoglycemic acgents

Answer 9

metformin

glyburide

Question 10

Metformin

Ax:

Better than insulin?

Dosage:

Answer 10

1. Axn: Inhibits liver make of glucose and glucose absorption; causes glucose uptake in tissue
2. Not better than insulin: does cross placenta
3. Start at 500mg daily but bad sx

Question 11

Glyburide

Ax:

Better than insulin?

Dosage:

Answer 11

Axn: Binds to pancreatic beta cell ATP/K receptors and increases insulin sensitivity peripheral tissues

2. Studies are mixed on amount of placental crossing – minimal. no short. term affects
3. 2.5 – 20 mg daily in divided doses

Question 12

when to rescreen

Answer 12

1. If pass first trimester, rescreen
2. If failed and was diagnosed, do not recreen

Question 13

Peripartum (during pregnancy) risk of GSM

Answer 13

increased risk for

1. preeclampsia,

2. LGA

3. delivery trauma to bb

Question 14

Compare and contrast peripartum and long-term risks to mother with. GDM

Answer 14

Long-term risk of developing type 2 DM (Hispanic patients at higher risk)

Question 15

Discuss potential newborn complications

Answer 15

Fetal risks:

1. Macrosomnia (big babies)
2. Neonatal hypoglycemia bc used to high glucose values
3. Hyper-bilirubinia
4. Birth trauma
5. Still birth
6. Increased risk and childhood onset obsesity And DB