Gestational Diabetes Flashcards
Definition of GDM
Any degree of glucose intolerance with onset or first recognition during pregnancy
A1 GDM
GDM managed with lifestyle/ nutritional therapy (responsive)
A2 GDM
GDM managed by medication (insulin)
Main hormone implicated in GDM
human placental lactogen
Other hormone implicated in GDM
Progesterone, Prolactin, placental section growth hormone, and Corticotropin releasing hormone
Risk factors for GDM
A. Obesity (>25 BMI)
B. Advance Age (>30)
C. Family history of DM
D. Previous GDM
Pathophysiology of Macrosomia
Maternal hyperglycemia -> fetal hyperglycemia -> stimulates fetal pancreas -> anabolic properties of insulin -> increase fetal tissue growth -> macrosomia
If pxt is low risk at prenatal check up, what do you do?
Schedule OGTT screening at 24-28 weeks
What makes Filipino immediately at high risk?
Population - Pacific Islanders
When is infant considers macrosomia?
For Over Diabetes: >4500g
For GDM: >4000g
Non-pharmacologic management for GDM
Diet, Isometric Exercise, and CBG monitoring
When would you begin to prescribe Insulin?
When non-pharmacological management does not suffice.
What FBS level is used as the threshold to diagnose overt diabetes
126 mg/dl
When should you screen for Type 2 DM in Pregnant Filipinos?
At first prenatal visit
What would you use to screen for type 2 GDM
Either FBS, Glycosylated Hb, or RBS
Screening cut-off for Overt Diabetes
FBS: >/= 126 mg/dl
RBS: >/= 200 mg/dl
HbA1c: >/= 6.5%
OGTT (75g, 2hr): >/= 200/dl
Screening cut off for GDM
75g OGTT (2hr)
A. FBS: >/= 92 mg/dL
B. 1hr: >/= 180 mg/dL
C 2hr >/= 153 mg/dL or 140 mg/dL
Screening follow up: No risk Factors w/ normal FBS/RBS/HbA1c
OGTT @ 24-28 weeks
If follow up screening at 24-28 weeks is normal, what happens next?
Screening at 32 weeks or earlier if with signs
Katniss is diagnosed with gestational diabetes that is controlled solely
with diet. Which of the following are important for the management of
her pregnancy at term?
A. Induction at 38 weeks’ gestation
B. Weekly umbilical artery Doppler studies
C. CS if estimated fetal weight is 3,800 grams
D. Expectant management until 40 weeks
D. Expectant management until 40 weeks
Expectant management until 40 weeks, but not beyond 40 weeks. Early induction <39 weeks may be associated with neonatal complications.
Timing of elective delivery
on or before 39 weeks
When should elective CS be considered
Festus is suspected to be obese
EFW >/= 4500g
Which of the following is a risk factor in pregnant women for impaired carbohydrate metabolism?
A. Family history of diabetes.
B. Previous infant with polycystic kidney disease
C. High serum levels of antiphospholipid antibodies
D. All of the above
A. Family history of diabetes
The risk of fetal death is three to four times higher in women with which of the following conditions affecting pregnancy?
A. Type 1 diabetes
B. Type 2 diabetes
C. Gestational diabetes
D. Impaired fasting glucose
A. Type 1 diabetes
Women with type 1 diabetes should achieve glycemic control with which of the following during pregnancy?
A. Insulin
B. Diet
C. Insulin and diet
D. Oral hypoglycemic agents
Basha, 28-year-old, G1P0 consulted for her first
C. Insulin and diet
Basha, 28-year-old, G1P0 consulted for her first prenatal check-up. Past medical and family histories are unremarkable. Her HbA1c is 5.0%. Which of the following is the appropriate next steps in her follow-up?
A. No need for subsequent screening for gestational DM.
B. Screen at 24-28 weeks using a 2-hour 75-gram OGTT.
C. If OGTT at 24-28 weeks is normal, re-test at 32-34 weeks using FBS.
D. If OGTT at 24-28 weeks is normal, re-test at 32-34 weeks using 75-g OGTT
B. Screen at 24-28 weeks using a 2-hour 75-gram OGTT.
Since she is a low-risk patient, we can simply request for the routine screening at 24-28 weeks using 2-hr 75g OGTT.
Maternal complications for GDM
Diabetic retinopathy
Diabetic nephorpathy
Diabetic neuropathy
Diabetic ketoacidosis
Preeclampsia
Infection
Wound complications
Fetal Complications in GDM
Macrosomia
Polyhydramnios
Spontaneous abortion
Preterm delivery
Malformation
Pathophysiology of Hydramnios
A. Fetal hyperglycemia -> polyuria -> hydramnios
B. Congenital anomaly (esopahgeal atresi) -> decrease intake of amniotic fluid -> hydroamnios
Treatment goal for GDM
Preprandial/FBS: </= 95 mg/dL
Premeal: </= 100 mg/dL
1hr: </= 140 mg/dL
2hr: 180 mg/dL
Treatment goal for pregnant pxt with preexisting DM
FBS/preprandial: 60-99 mg/dL
Peak postprandial: 100-129 mg/dL
HbA1C: </= 6.0%
Drug of choice for GM in pregnancy?
Insulin
Insulin Regimen: Basal Insulin
1st Trimester: 0.7-0.8 units/kg
2nd Trimester: 0.8 - 1.0 units/kg
3rd Trimester: 1.0-2.0 units/kg
2/3 breakfast, 1/3 at night
