gestational diabetes Flashcards
GDM % of diabetes in pregnancy
90%
Maternal complications of GDM
preeclampsia
increased probability of CS
increased his kof non-GDM diabetes later in life (70%)
neonatal complications of GDM
macrosomnia (PPH, operative delivery, etc) hypoglycemia hyperbilirubinemia shoulder dystocia still birth
GDM screening 1h GTT
50 gm
- 24-28w
- positive 130-140 (based on local rates in the community)
early 1h GTT
(<24w)
- prior GDM
- obesity (>25)
- other risk factors for GDM
3h GTT screening
- 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)
Benefits of treatment GDM
lower incidence of: LGA perinatal death should dystocia neonatal birth trauma preeclampsia
sugar monitoring GDM
fasting (95)
1-2 hour post prandial (140 1h, 120 2h)
macrosomina is more associated with post prandial more Ethan fasting
Treatment GDM
1) dietary: 40% carbs, 40% fat, 20% protein
2) insulin/meds
medical treatment of GDM
- insulin is 1st line, oral meds 2nd line
- oral agents: glyburide, metformin
- IM: insulin
glyburide GDM
oral agent (2nd line) Daily dose: 2.5-30mg best used for pts with T2DM/T1DM and PCOS
metformin
oral agent
GDM
associated with increased risk of PTB
Daily dose 500 mg nightly one week > 500 mg BID thereafter
insulin GDM
- initial daily dose 0.7-1.0 u/kg/day
- additional added if fasting, PCs are high (95, 140 or 120)
Fetal monitoring GDM
- begin at 32w for poorly controlled
- unclear with well controlled how helpful it is
Delivery GDM
- well controlled A1DM: 39-40.6
- well controlled A2DM: 39-39.6
- poorly controlled 37-38.6