gestational diabetes Flashcards

1
Q

GDM % of diabetes in pregnancy

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Maternal complications of GDM

A

preeclampsia
increased probability of CS
increased his kof non-GDM diabetes later in life (70%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

neonatal complications of GDM

A
macrosomnia (PPH, operative delivery, etc)
hypoglycemia
hyperbilirubinemia
shoulder dystocia
still birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

GDM screening 1h GTT

A

50 gm

  • 24-28w
  • positive 130-140 (based on local rates in the community)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

early 1h GTT

A

(<24w)

  • prior GDM
  • obesity (>25)
  • other risk factors for GDM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

3h GTT screening

A
  • only if 1h is positive
  • Positive if any of the 2 values are met
  • 95/180/155/140
  • 105/190/165/145 (either of these are used for cut offs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Benefits of treatment GDM

A
lower incidence of: 
LGA
perinatal death
should dystocia
neonatal birth trauma
preeclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

sugar monitoring GDM

A

fasting (95)
1-2 hour post prandial (140 1h, 120 2h)

macrosomina is more associated with post prandial more Ethan fasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment GDM

A

1) dietary: 40% carbs, 40% fat, 20% protein

2) insulin/meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

medical treatment of GDM

A
  • insulin is 1st line, oral meds 2nd line
  • oral agents: glyburide, metformin
  • IM: insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

glyburide GDM

A
oral agent (2nd line)
Daily dose: 2.5-30mg
best used for pts with T2DM/T1DM and PCOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

metformin

A

oral agent
GDM
associated with increased risk of PTB
Daily dose 500 mg nightly one week > 500 mg BID thereafter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

insulin GDM

A
  • initial daily dose 0.7-1.0 u/kg/day

- additional added if fasting, PCs are high (95, 140 or 120)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fetal monitoring GDM

A
  • begin at 32w for poorly controlled

- unclear with well controlled how helpful it is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Delivery GDM

A
  • well controlled A1DM: 39-40.6
  • well controlled A2DM: 39-39.6
  • poorly controlled 37-38.6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

dystocia increases when (GDM)

A

1% > 10% when delivered beyond 40w

600 CD needed EFW >4500 to prevent one permanent brachial plexus injury

17
Q

pp GDM

A
  • increased risk problems later in life
  • need to be screen 6-12w pp with 75 mg 2h GTT
  • if positive, do lifestyle/dietary changes. Then annual screening for 3 years to follow