gestational diabetes Flashcards
gestational diabetes mellitus (GDM)
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.
what is the MC medical complication & metabolic d/o of pregnancy?
GDM
occurs in 2-14% of population
ethnic groups w/ higher incidence of Type 2 diabetes, therefore GDM
Hispanic Americans
African Americans
Native Americans
Pacific Islanders
increased insulin release
maternal estrogens & progesterone
metabolic changes during pregnancy are essential for what to be delivered to the developing fetus
adequate nutrients
what results in lower fasting glucose levels
increase in peripheral glucose utilization & glycogen storage w/ reduction in hepatic glucose production
what rises linearly throughout the 2nd & 3rd trimesters?
placental steroids & peptide hormones
i.e. human chorionic sommatomammotropin
cortisol, prolactin, progesterone, estrogen
placental steroids & peptide hormones increase what
tissue insulin resistance which means the demand for insulin increases
the bodies demand for insulin increases between what weeks of pregnancy?
24th-28th
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.
borderline pancreatic function
during a healthy pregnancy, mean fasting blood glucose levels decline to an avg. of what
74 mg/dL
peak postprandial values rarely exceed
120 mg/dL
meticulous glucose ctrl during pregnancy has been shown to reduce what
risk of macrosomia
<120 mg/dL 20% develop
up to 160 mg/dzl 35% develop
risk assessment for GDM should be done when
1st prenatal visit
clinical characteristics consistent with high risk
advanced maternal age morbid obesity hx of GDM glycosuria strong FH of DM
high risk pts should undergo testing for GDM as soon as feasible. If initial screening is negative repeat screening should be done at
24-28 wks
avg risk pts should have testing done?
24-28 wks
low risk pts must meet what requirements in order to avoid glucose testing?
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
one-step approach to GDM screening
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
the one-step approach for GDM screening is cost effective in what population
high-risk pts/ populations
two-step approach to GDM detection for avg. risk at 24-28 wks
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
When does the 3 hr OGTT not need to be performed?
1 hr 50g glucose screen >185 mg/dL or a fasting >126 mg/dL
the 100g 3 hr OGTT
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
Criteria of positive 100gm OGTT
fasting glucose: 95mg/dL
1 hr glucose: 180mg/dL
2 hr glucose: 155mg/dL
3 hr glucose: 140mg/dL
