Gestational diabetes

Question 1

Maternal and fetal complications

Answer 1

preeclampsia and Cesarean delivery
70% of women with TDM will develop type two diabetes within 25 years after pregnancy

Offspring have increased risk of macrosomia, neonatal hypoglycemia, shoulder dystocia , birth trauma, stillbirth, Childhood and adult obesity and diabetes in offspring

Question 2

Oral antidiabetic medication

Metformin

Glyburide

Answer 2

Metformin- biguanide that inhibits gluconeogenesis
Crosses the placenta so long-term fetal effects are unknown

Glyburide- sulfonylurea that binds to pancreatic beta cells to increase insulin secretion and sensitivity and peripheral tissues. Associated with higher rates of neonatal hypoglycemia and higher rates of macrosomia than insulin
Also higher rate of hyperbilirubinemia, stillbirth and preeclampsia

Question 3

Delivery mode and timing

scheduled cesarean delivery

Answer 3

Well controlled GDMA2 should not be delivered before 39 weeks

Poorly controlled tedium 82 should be delivered between 37 and 39

4500 g

Question 4

Postpartum testing for type two diabetes

Answer 4

2 hr GTT 75g load

Fasting > 125
2 hr Post prandial >199

Question 5

Fetal risk of type one or type two diabetes

Answer 5

SAB
Congenital malformations, cardiac is most common(septal)
Skeletal
NTD
caudal regression

Question 6

Neonatal risk of type one and type two diabetes

Answer 6

RDS
Hypoglycemia
Hyperbilirubinemia
Polycythemia
Cardiomyopathy
Hypothermia

Question 7

Who should get early GDM Screen?

Answer 7

BMI >25
AND
Hx of GDM 
HX of infant 4000g
HTN
HX of CVD
A1c >5.7%
HDL <35 or trig >250

Question 8

Congenital anomalies associated with pregestational diabetes

Answer 8

Caudal regression
Cardiac anomalies (ASD/VSD, transposition of great vessels)
NTD

Question 9

Insulin dosing

Answer 9

0.7u/kg in early preg, 1u/kg at term
2/3 total insulin in AM, 2/3 long acting and 1/3 short acting

1/3 total insulin PM, 1/2 long acting, 1/2 short acting