Gestational Diabetes

Question 1

What is the difference between A1 and A2 GDM?

Answer 1

• A1 = adequate control without medication

- A2 = diabetes that requires medication

Question 2

What are the 2 main consequences of excessive maternal glucose levels?

Answer 2

1. fetal hyperglycemia

2. fetal hyperinsulinemia

Question 3

What finding on the glucose tolerance test is definitive for diabetes?

Answer 3

glucose > 200 mg/dL

Question 4

What is the screening protocol for GDM?

Answer 4

random 50 g oral glucose test sometime between 24-28 weeks

Question 5

What is the diagnostic test for GDM?

Answer 5

3-hr 100mg glucose tolerance test

2+ values must be abnormal

Question 6

If a patient had GDM or is obese when should they be screened?

Answer 6

in the first trimester

Question 7

What is the recommended course of treatment if a patient only had ONE abnormal value on 3-hr OGTT?

Answer 7

• repeat 3-hr OGTT in 2-4 weeks

- OR monitor blood glucose levels

Question 8

How is macrosomia defined?

Answer 8

fetal weight >90th percentile OR >4000gm

Question 9

What are the 3 most common birth injuries associated with DM?

Answer 9

• brachial plexus injury
• facial nerve injury
• cephalohematoma

Question 10

What is the most concerning birth injury associated with macrosomia?

Answer 10

shoulder dystocia

Question 11

To avoid birth trauma ACOG recommends considering a c-section in diabetic pregnancies if the fetal weight is > ______ g.

Answer 11

> 4500 g

Question 12

What is the main treatment for GDM?

Answer 12

• diet therapy

Question 13

What is the mainstay medical therapy for GDM?

Answer 13

insulin

does not cross the placenta

Question 14

In patients with A2GDM weekly NST are started when?

Answer 14

32 weeks then 2x weekly at 36 weeks