Gestational diabetes

Question 1

1st trimester metabolic changes

Answer 1

increased ins sensitivity which increases adipose deposition

high blood glucose can cause congenital abnormalities

Question 2

2nd and 3rd tri metabolic changes

Answer 2

increased ins resistance to get adequate glucose to fetus

increased in glucose uptake
increased insulin production by fetus

**high levels can increase birth weight

Question 3

hPGH

Answer 3

human placental growth hormone

similar to GH and PRL but not regulated by GHRH

85%of GH activity is due to hPGH

**increases blood glucose

Question 4

normal pregnancy metabolic events

Answer 4

low fasting plasma glucose and higher fasting insulin in first trimester (hyperinsulinemia)

Question 5

GDM definition and risk factor

Answer 5

glucose intolerance of variable severity that only occurs during pregnancy

DM in family 
hx of glucose intolerance
OB
age
ethnicity
previous birth of >9-10 lbs (macrosomia)

Question 6

3 abnormalities in GDM

Answer 6

1) insulin resistance
2) impaired ins secretion (glucose intolerance) i
3) increased hepatic glucose production

** note that these changes are expected to be seen in pregnancy

Question 7

neonatal hypoglycemia in GDM

Answer 7

infants to mother’s with GDM

fetus is producing a TON of insulin bc they are used to a high glucose environment

but upon delivery, when the high glu environment is removed, there is increased insulin which causes hypoglycemia

Question 8

treatment of GDM

Answer 8

exercise
diet changes

second line: insulin therapy