Gestational Diabetes

Question 1

What is A1 Gestational diabetes?

Answer 1

Gestational diabetes diagnosed in pregnancy and controlled with diet alone

Question 2

What is A2 Gestational Diabetes?

Answer 2

Gestational diabetes dx in pregnancy and controlled with medication and diet

Question 3

Risk factors for Gestational Diabetes

Answer 3

BMI >25

FH Diabetes

Race/ethnicity

Previous hx of large-for-gestational age infant

Previous GDM

HTN

PCOS

H/o CVD

A1C >5.7%

Question 4

When would a pregnant pt be screened for GDM?

Answer 4

All patients b/w 24-28 weeks

Question 5

What is the two step approach to screening for GDM?

Answer 5

1 hour glucola test (take 50g of glucola)

If abnormal result (130-140mg/dL) => 3 hr glucose tolerance test

Positive GDM if >200 mg/dL

Most sensitive test**

Question 6

Treatment for GDM

Answer 6

Dietary changes (50% carbs, 25% protein, 25% fat)

Exercise 150 minutes/week

Question 7

When is blood glucose monitored in pts with GDM?

Answer 7

Fasting

1-2 hours after meals

Question 8

What is the gold standard medication for GDM? Why?

Answer 8

Insulin

Safest for pregnancy - does not cross placenta

Question 9

What is the biochemical effect of metformin?

Answer 9

Inhibits gluconeogenesis and glucose absorption

Stimulates glucose uptake in peripheral tissues

Question 10

Why is glyburide less indicated for management of GDM?

Answer 10

Causes fetal hypoglycemia

Question 11

What are the maternal risks of GDM?

Answer 11

Increased risk of: preeclampsia, LGA, delivery trauma to fetus

Future risk of developing Type 2 DM (especially hispanic pts)

Question 12

Fetal risks for GDM

Answer 12

Macrosomia (large babies)

Neonatal hypoglycemia

Hyperbilirubinemia

Shoulder dystocia

Birth trauma

Stillbirth

Increased risk of childhood obesity and diabetes

Question 13

In what situations would a pt with gestational diabetes deliver prior to 39 weeks?

Answer 13

Preexisting diabetes

Poorly controlled diabetes

Question 14

How long after birth should mom be screened for GDM?

Answer 14

6 weeks

2 hr GTT

Question 15

How often would you screen a patient with hx of GDM?

Answer 15

Every 1-3 years after delivery

Question 16

In a postpartum screening for diabetes, what lab values meet criteria for diabetes mellitus?

Answer 16

Fasting plasma glucose (FPG) >125 mg/dL OR

2 hr GTT >199 mg/dL

Question 17

In postpartum screening for diabetes mellitus, what lab values correspond with impaired fasting glucose?

Answer 17

FPG 100-125 mg/dL OR

2 hr GTT 140-199 mg/dL