GDM

Question 1

Blood glucose tx targets

Answer 1

Fasting <=5.5
1 hr post prandial<= 7.4
2 hr post prandial <= 6.7

Question 2

Hba1c and glucose testing

Answer 2

> 50-probable undiagnosed
41-49-ogtt
<=40- 1hr

Question 3

Weight gain during pregnancy

Answer 3

Underweight 12.7-18.1
Normal 11.3-15.9
Overweight 6.8-11.3
Obese 5.0-9.0

Question 4

ADIPs cutoff levels for fasting, 1 hour and 2 hour

Answer 4

Fasting 5.1-6.9
1 hour 75g >10
2 hour 8.5-11

Question 5

Major Risk factors for GDM

Answer 5

Previous GDM
Mat age>40
Fam hx
South Asian
BMI >35
Previous macrosomia
PCOS with hyper androgen isn’t
Meds: corticosteroids, antipsychotics

Question 6

Mod RF for GDM

Answer 6

Age 35-39
Ethnicity: abo, Maori, PI
BMI 25-35
PCOS

Question 7

Diabetes in pregnancy by glucose

Answer 7

Fasting >or=7

2 hour > or = 11.1

Question 8

Blood glucose in pregnancy effects

Answer 8

20% lower than outside pregnancy
Mean peak is 1 hour postprantial
Post-breakfast BGLs are the most variable
1 hour post-meal BGL after 32/40 correlated with fetal AC

Question 9

Degree of fall in insulin requirement that suggests altered placental function

Answer 9

> 15-20%

Question 10

Mechanism of fetal compromise

Answer 10

Fetal hypoxia and/or acidaemia
Raised EPO
Extra medullary haematopoiesis
Thickened basement membrane of chorionic villi

Question 11

Polyhydramnios in GDM

Answer 11

Fetal polyuria related to hyperglycaemia induced osmotic dieresis

Question 12

Pathophysiology of GDM

Answer 12

50% reduction in insulin sensitivity by the third trimester as a result of placental hormones

Question 13

Effect of pregnancy on diabetes

Answer 13

Acute: hypoglycaemia, infection, ketoacidosis

Long-standing: microvascular, nephropathy, retinopathy

Question 14

Effects of diabetes on pregnancy

Answer 14

Maternal: miscarriage, PIH, PET, periodontal disease, CS, UTIs, other infections, obstetric trauma

Fetal complications: congenital abnormalities (cardiac and renal, NTD, sacral agenesis), hypoglycaemia, SB, Poly, birth injury, macrosomia, FGR, postnatal adaptation problems

Question 15

PET risk

Answer 15

10-20%

Question 16

How hyperinsulinaemia causes RDS

Answer 16

Inhibits normal stimulators effect of cortisol on lecithin synthesis

Question 17

Why get hyperbilirubinemia

Answer 17

Increase red cell formation and haemolysis assocaiated with poor glycaemic control

Question 18

Increased risk of diabetes to fetus

Answer 18

Type 1 5-6%

Type 2 10-15%

Question 19

DKA definition

Answer 19

Hyperlgyacemia (>11)
Acidosis (venous pH <7.3 or bicarbonate <15
KKetonaemia or ketonuria

Question 20

Pathophysiology of pregnancy predisposing to DKA

Answer 20

Increased insulin resistance
Accelerated starvation (high fetal and placental glucose demand)
Reduced buffering capacity (due to increased ventilation, respiratory alkalosis and compensatory renal excretion of bicarbonate)

Question 21

Treatment of DKA

Answer 21

Aggressive volume replacement
Insulin infusion
Monitoring electrolytes
Correct any ppt factors (infection, vomiting, poor control, beta sympathomimetic drugs, antenatal corticosteroids)

Question 22

GDM definition

Answer 22

Carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy