Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB > gestational diabetes > Flashcards

gestational diabetes Flashcards

1
Q

gestational diabetes mellitus (GDM)

A

any degree of glucose intolerance w/ onset or 1st recognition during pregnancy. This does not exclude the possibility that unrecognized glucose intolerance has antedated or begun concomitantly w/ the pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the MC medical complication & metabolic d/o of pregnancy?

A

GDM

occurs in 2-14% of population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ethnic groups w/ higher incidence of Type 2 diabetes, therefore GDM

A

Hispanic Americans
African Americans
Native Americans
Pacific Islanders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

increased insulin release

A

maternal estrogens & progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

metabolic changes during pregnancy are essential for what to be delivered to the developing fetus

A

adequate nutrients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what results in lower fasting glucose levels

A

increase in peripheral glucose utilization & glycogen storage w/ reduction in hepatic glucose production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what rises linearly throughout the 2nd & 3rd trimesters?

A

placental steroids & peptide hormones
i.e. human chorionic sommatomammotropin
cortisol, prolactin, progesterone, estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

placental steroids & peptide hormones increase what

A

tissue insulin resistance which means the demand for insulin increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

the bodies demand for insulin increases between what weeks of pregnancy?

A

24th-28th

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

the pancreas releases 1.5-2.5 times more insulin to respond to the increase in insulin resistance. pts w/ nml pancreatic function are able to meet these demands, but people w/______________________leads to inadequate insulin secretion in the presence of increasing insulin resistance.

A

borderline pancreatic function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

during a healthy pregnancy, mean fasting blood glucose levels decline to an avg. of what

A

74 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

peak postprandial values rarely exceed

A

120 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

meticulous glucose ctrl during pregnancy has been shown to reduce what

A

risk of macrosomia
<120 mg/dL 20% develop
up to 160 mg/dzl 35% develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

risk assessment for GDM should be done when

A

1st prenatal visit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

clinical characteristics consistent with high risk

A 
advanced maternal age
morbid obesity
hx of GDM
glycosuria
strong FH of DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

high risk pts should undergo testing for GDM as soon as feasible. If initial screening is negative repeat screening should be done at

A

24-28 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

avg risk pts should have testing done?

A

24-28 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

low risk pts must meet what requirements in order to avoid glucose testing?

A 
age<25 yo
wt nml pre-pregnancy
member of ethnic group w/ low GDM prev.
no known DM in 1st degree relative
no hx of abnormal glucose tolerance
no hx of poor OB outcome/ macrosomic infant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

one-step approach to GDM screening

A

perform a diagnostic 3 hr oral glucose tolerance test (OGTT) w/o prior plasma/ serum glucose screening
pt must be on unrestricted diet x3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

the one-step approach for GDM screening is cost effective in what population

A

high-risk pts/ populations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

two-step approach to GDM detection for avg. risk at 24-28 wks

A

Step 1: plasma glucose concentration 1 hr after a 50g oral glucose load
If results:
>140 mg/dL= schedule pt for 3 hr OGTT
>130 mg/dL=ID’s 90% of pts w/ GDM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When does the 3 hr OGTT not need to be performed?

A

1 hr 50g glucose screen >185 mg/dL or a fasting >126 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

the 100g 3 hr OGTT

A

must be done after 3 days of unrestricted carbohydrate diet & while pt is fasting

venous plasma glucose measured at 1, 2, & 3 hrs after

+ test requires 2 values be met or exceeded. 1 abnormal value should be followed w/ repeat test one month later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Criteria of positive 100gm OGTT

A

fasting glucose: 95mg/dL
1 hr glucose: 180mg/dL
2 hr glucose: 155mg/dL
3 hr glucose: 140mg/dL

25
Q

what are the immediate risks to the mother w/ GDM?

A

increased incidence of c-section
preeclampsia
polyhydraminos

26
Q

what are the long term risks to the mother w/ GDM?

A

recurrent GDM & high risk for developing diabetes

27
Q

immediate risk to the infant from GDM

A 
macrosomia (d/t excessive fetal insulin d/t increased delivery of glucose & amino acids to the fetus via maternal circulation)
shoulder dystocia (d/t macrosomia)
28
Q

Macrosomia definition

A

birth wt above 90th percentile for gestation age or > than 4000g (8.8lbs)

29
Q

shoulder dystocia can result in what?

A

brachial plexus injury
clavicular fracture
fetal distress
low APGAR scores

30
Q

with extremely poor glucose control there is an increase in what?

A

fetal mortality d/t fetal acidemia & hypoxia

neonatal hypoglycemia

31
Q

Long term risks to infant from GDM

A

increased risk of adolescent obesity & type 2 diabetes

32
Q

What is the foundation for the tx of GDM?

A

dietary therapy

33
Q

what is the ADA recommended dietary therapy?

A

2000-2500 kcal/d (35 kcal/kg present pregnancy wt) w/ 50-60% carbs (35-40%), 10-20% protein & 25-30% fat (<10% saturated fat)

34
Q

other recommendations of dietary therapy

A

30 kcal/kg if nml wt
24 kcal/kg if overwt
12 kcal/kg if morbidly obese

35
Q

in at least 1/2 of the cases, diet alone will maintain what?

A

fasting & postprandial blood glucose values w/in target range

36
Q

post prandial values have been more strongly associated w/ what?

A

risk of macrosomia

37
Q

modest carbohydrate restriction 45% of total calories may blunt what?

A

postprandial glucose

38
Q

how often should glucose monitoring be done w/ GDM

A

@ least weekly w/ a fasting glucose & a 1 hr postprandial

increase/ decrease frequency PRN

39
Q

T/F- there are oral diabetes meds currently approved for use in pregnancy

A

FALSE

study using insulin & glyburide showed no difference

40
Q

what drug is not FDA approved but is being utilized by diabetes centers

A

Glyburide- it doesn’t cross the placenta

41
Q

recommendations for initiating insulin therapy are

A

fasting plasma glucose is >105 mg/dL
1 hr postprandial glucose levels >140 mg/dL
2 hr postprandial >120 mg/dL
macrosomia may be further reduced if insulin is initiated when FPG >95 mg/dL

42
Q

target glucose levels

A

fasting values 50-90 mg/dl
preprandial 60-105 mg/dl
2 hr postprandial <130 mg/dl
2-6 am value 60-90 mg/dl

43
Q

NPH, regular, aspart, lispro are category what?

A

B

44
Q

insulin glargine is pregnancy cat. ?

A

C

45
Q

lantus insulin has a high affinity to what type of receptors?

A

IGF-1 receptors

not recommended in pregnancy

46
Q

insulin detemir is a cagegory?

A

C
has low affininity for IGF-1
not currently used in pregnancy, but may be best bet at some point

47
Q

exercise as an adjuvant therapy in GDM

A

fetal safety has been estab. if maternal heart rate is maintained <1 hr & the mother stays hydrated & does not get over heated

48
Q

imaging studies/ procedures

A

growth ULS for fetal size- do bet. 36-37 wks

49
Q

amniocentesis is used to check___________________if delivery is contemplated prior to 39 wks gestation

A

fetal lung profile

50
Q

fetal mvnt counting

A

every night @ 28 wks in <60 min
10 mvnts is good
all pts should do

51
Q

non stress test

A

twice weekly
2 heart rate accels in 20 min
begin at 28-30 wks w/ insulin at 36 wks w/ diet

52
Q

contraction stress test

A

weekly
no HR decels in response to 3 contractions in 10 min
begin in all pts at 28-30 wks?

53
Q

ULS biophysical profile

A 
weekly
score of 8 in 30 min
3 mvnts=2
1 flexion=2
30 secs of birthing=2
2cm amniotic fluid=2
54
Q

Pts can progress to term if

A

GDM is uncomplicated & controlled w/ diet, unless other complications arise

55
Q

estimating fetal wt is done how

A

serial ULS’s

plays a major role in decision making process for route of delivery

56
Q

postpartum follow up

A

counsel on high risk for recurrent GDM
screen for DM 6 wks post partum- if nml reassess at min of 3 yr intervals
monitor annually women w/ impaired fasting glucose or impaired glucose tolerance

57
Q

in order to improve insulin sensitivity & attempt to prevent developing type II DM, what should be started postpartum?

A

wt loss program consisting of diet & exercise

58
Q

what helps to decrease the chance of developing type II DM as well as decreases the risk of iinfant obesity & impaired glucose tolerance?

A

breastfeeding, unless difficulties in glycemic control

OB (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions