gestational diabetes Flashcards
gestational diabetes
hyperglycemia during pregnancy in otherwise non-diabetic women, diagnose with 24-28 week OGTT
prevalence of gestational diabetes
2-10% of pregnancies
insulin secretion during early pregnancy
increased insulin response, can cause hypoglycemia in T1D
Why is insulin response increased in early pregnancy?
growth of placenta and increase maternal fat storage
insulin secretion during late pregnancy
reduced insulin sensitivity
effects of gestational diabetes
may cause fetal growth problems and can lead to macrosomia (fat baby). because fetus has access to excessive glucose, it produces levels of insulin and stores the excess glucose as fat
why is there reduced insulin sensitivity?
growth of the placenta, normally the body will compensate with increased insulin secretion. women with gestational diabetes cannot compensate
Complications of gestational diabetes
damage to baby during birth (particularly shoulders)
neonatal hypoglycemia
breathing problems
increased risk of Type 2 diabetes
neonatal hypoglycemia cause
baby produces more insulin due to excess insulin from mom, once baby is born high glucose is gone, but increased insulin continues
breathing problems for baby in gestational diabetes
high glucose or high insulin levels can delay maturation of the lungs
maternal insulin resistance in gestational diabetes
inability of target tissues to respond to insulin
insulin doesn’t cross the placenta but glucose does
factors secreted by the placenta into maternal circulation
CRH-cortisol in gestational insulin resistance
both increase as pregnancy, glucocorticoids oppose insulin action
placental GH (GH-V) in gestational insulin resistance
released during last half of gestation, may contribute to insulin resistance
placental lactogens (PL) in gestational insulin resistance
increases as pregnancy progresses, 85% identical to GH-contributes to insulin resistance
Treatment of Gestational diabetes
diet, exercise, insulin (gold standard), glyburide, metformin
