Gestational Diabetes Flashcards
Impaired glucose tolerance during pregnancy
Affects 1 in 10 pregnancies globally
Gestational diabetes GDM
A1
Fasting <105, 2 hrs postprandial <120
Diet therapy
A2
Fasting >105, 2 hrs postprandial >120
Insulin therapy
Classes
Insulin resistance (diabetogenic effect)
Produced estrogen, costisol, and HCS causes insulin resistance, making maternal bloodstream hyperglycemic
Insulin needs
Increases during pregnancy
Drops during delivery
Insulin production during GD
Shortage in insulin
Effects of Pregnancy on diabetes
- Altered carbohydrate metabolism
- Impaired insulin action
- Accelerated vascular changes
- Accelerated starvation
- Higher risk of ketoacidosis
DKA- diabetic ketoacidosis
Hyperglycemia
Insulin resistance
Adiposes has fatty acids converted to ketones in liver
DKA manifestation
Malaise
Headace
Nausea*
Vomiting*
Coma
Death
Fetal death
Risk Factors for GDM
Obesity
Hypertention
>25 yrs
Family history
OB History of stillbirth or fetal macrosomia
Preeclampsia
Polyhydramnios, fetal urine
Weight gain
DKA
Potential fetal complications
Macrosomia
Hyperglycemic coma- stillbirth
Prematurity
Congenital anomalies
Cardiomyopathy
Postpartum complications
Hypoglycemia
Hypothermia
Respiratory distress
Jaundice
Birth injury
Glucose intolerance
Obesity
Potential infant complications postpartum
Polycythemia
Hypoglycemia
Hypothermia
Hypocalcemia
Diagnosing GDM
Screening
- OGTT 1 hr non fasting, 50g glucose
>100 is positive
>140 diagnosis
- OGTT 3 hr fasting, 100g
Hour 1,2,3
Hemoglobin A1c Test
Glucose sticks to hemoglobin A for 3 months, measures A1c test result
Education
Diagnosis and risk
Diet and nutrition
Medication
Postpartum risks
Polydipsia
Polyphagia
Polyuria
SIGNS OF HYPERGLYCEMIA
Nervous
Headace
Weakness
Irritability
Hungry
Blurry vision
Shaking
SIGNS OF HYPOGLYCEMIA
Management
Prevent fetal complications
Prevent DKA
Detect complications
Fetal wellbeing
Daily fetal movement counting
Amniotic fluid index
Biophysical profile BPP
Test done 2x a week
32-34 wks
Diet controlled
34-36 wks
Fetal wellbeing
Medication
Glyburide
Insulin- maintian blood glucose
Neonatal hypoglycemia
Glucometer is >40 mg/dL
Infant is term and able to feed
Draw blood and feed 10-15mL or Glucose
Re-test
Infant Hypoglycemia
< 20 mg/dL E*
<40 mg/dL NPO/ preterm
<40 mg/dL after feeding
< 40 mg/dL symptomatic
Postpartum considerations
GDM is in higher risk of t2 diabetes
After delivery
Maternal levels return to normal
Not discharged 48 hrs
FBS
2hr PPG
After 3 days
75g OGTT
After 6 days
Fasting
Fasting
Normal 70-100
IGT- 100-125
Diabetes >126
75 g 2hr OGTT
<140
140-199
>200
