Gestational Diabetes Flashcards
What is gestational diabetes?
glucose intolerance diagnosed in pregnancy
GH, CRH, and placental lactogen –> insulin resistance
prolactin, progesterone, and cortisol contribute
What are the two classes of gestational diabetes?
A1: diagnosed in pregnancy and controlled w/ diet alone
A2: diagnosed in pregnancy and controlled w/ diet and glyburide or insulin
What is the prevalence of GDM?
7% of pregnancies complicated by DM - 86% are gestational
increasing in prevalence
What are risk factors of GDM?
overweight (BMI > 25
and:
FH diabetes
high risk race/ethnicity
previous LGA infant
previous GDM
HTN
PCOS
high A1c
What is the basic screening strategy for GDM?
1973
if screen on risk factors alone - miss 50%
all patients btw 24-28 weeks
2 step approach: 1 hr glucose tolerance test (abnormal result 130-140, 80-90% sensitivity
if abnormal –> 3 hr gtt –> if greater than 200 –> diabetic education
How do you perform the 3 hr glucose tolerance test?
fasting
blood test every hour for 3 hrs
2 abnormal values = diagnostic
What are alt screening regimens besides 3 hr gtt?
2 hr gtt
HgA1C
fasting glucose
random glucose monitoring
What are dietary recommendations for GDM?
caloric intake based on weight
50% carbs, 25% protein, 25% fat
breakfast 20% lunch 30% dinner 30% snack 20%
What are exercise recommendations for GDM?
moderate exercise 3-5x week
goal 150 min/week
greatly improves glucose control
How effective are dietary changes for GDM?
what could you do if it doesn’t work?
70-80% can achieve euglycemia
oral hypoglycemic agents (glyburide, metformin)
What is metformin?
biguanide
inhibits hepatic gluconeogenesis and glucose absorption
stimulates glucose uptake in peripheral tissues
lack of superiority to insulin
crosses placenta
no long term data on neonatal effects
What is glyburide?
sulfonylurea
binds to pancreatic beta cell ATP/K receptors
increases insulin sensitivity in peripheral tissues
can get fetal hypoglycemia
not superior to insulin
not recommended as first line therapy
Does insulin cross the placenta?
no
What are the maternal risks of GDM?
increased risk of: preeclampsia, LGA, delivery trauma
future risk of dev. type 2 DM (4x in first 5 yrs, 10x in 10 yrs, 70% in 20-28 yrs)
60% of latin american women will dev DMT2 within 5 yrs of pregnancy
What are fetal risks of GDM?
macrosomia (big baby)
neonatal hypoglycemia
hyper-bilirubinemia
shouler dystocia
birth trauma
increased risk of childhood and adult onset obesity and diabetes
