Gestational Diabetes Flashcards
gestational diabetes?
screened?
glucose intolerance in pregnancy
24 or 28 weeks
White’s Classification?
what kind of diabetes is found, risks, and how we treat them.
A1 is diet controlled gestational –> watch them closely
A2 is medication controlled gestational
Risk factors?
BMI over 25
AND
FH diabetes
race/ethnicity
previous GDM
Polycystic ovarian syndrome
2 step approach to screening?
1 hour glucola (drink 50g of glucose).. check it 1 hour later. if you’re between 130 and 140 it’s abnormal. you failed it.
now 3 hour glucola test (fast, test blood every 3 hours, stuck 4 times ,drink a lot of glucola).. fail that, GDM.. between 130 and 140
fail both of those, gestational diabetes mellitus
if over 200 on 1 hour or 3 hour, diabetic education.
HgA1C
not accurate way because your plasma volume goes up so we dilute it.
dietary changes for GDM?
50% carbs, 25% protein, 25% fat
4 meals, B/L/D/ snack
medication management?
oral hypoglycemic agents
INSULIN is the gold standard.
Metformin?
cross placenta or no?
inhibits hepatic gluconeogenesis and glucose absorption.
can cross the placenta.
Glyburide
Sulfonylurea
increases sensitivity in peripheral tissues
Insulin
cross placenta or no?
does not cross placenta
as you go through pregnancy you have to dose higher because thing revs up.
risks of diabetes in pregnancy?
preeclampsia –> hypertension in pregnancy
LGA
delivery trauma –> wider in the shoulders..
risk of developing Type 2 DM
fetal risks for GDM?
Macrosomia (big babies)
Neonatal hypoglycemia
Hyperbilirubinemia
Shoulder Dystocia
Antepartum surveillance
identify a problem before its too late.
Non Stress Test
when do you deliver A1DM pt?
A2DM?
Preexisting diabetes?
poorly controlled
after 39
at 39 weeks iso
38
37
Intrapartum management
reduce risks of preeclampsia, LGA, and shoulder dystocia
Postpartum management
2 hour oral GTT to see if they were an undiagnosed Type 2 diabetic and has it resolved
PCP follow up
preventative therapy (risk for diabetes down the road)
Postpartum Screening
fasting plasma glucose greater than 125 for fasting glucose or 2 hour test greater than 199, you are diagnosed by diabetes.
the middle is between 100-125 fasting plasma glucose or 140-199 for the 2 hour test.. they are pre-diabetic
averages for A1C?
3 or 4
elevated blood pressure, proteinuria.. what is it?
preeclampsia
