Gestational Diabetes Lecture (Dr. Krila)

Question 1

Risk Factors of Gestational Diabetes Mellitus

Answer 1

1) Maternal Obesity
- Pre Pregnancy with 110% or more of IDEAL Body Weight or BMI OVER 30 kg/m^2

2) Maternal Age (OVER 25!!!!!)
3) Previous Delivery of Baby LARGER THAN 9 LBS!!!!!
4) History of Unexplained PERINATAL LOSS or MALFORMATION
5) Family history of DIABETES, especially with FIRST DEGREE Relative OF MOTHER!!!!!!!!
6) GLYCOSURIA at First Pre-Natal visit (DIPSTICK URINE)

Question 2

Risk Factors of Gestational Diabetes Mellitus Cont

Answer 2

7) METABOLIC SYNDROME!!!!!!!!!!!
* ** 3 or More of Risk Factors for Atherosclerotic Disease and T2DM**
- INSULING RESISTANCE
- Elevated FASTING GLUCOSE
- HYPERTENSION
- Elevated TRIGLYCERIDES
- REDUCED HDL Cholesterol
- Abdominal OBESITY

8) POLYCYSTIC OVARIAN SYDROME (PCOS)
- Chronic an ovulation in the setting of OBESITY, HYPERINSULINEMIA, T2DM, LIPID Abnormalities, HIRSUTISM, INFERLITY and Ovarian CYSTS

9) HYPERTENSION

10) GLUCOCORTICOID use at TIME of Pregnancy
- Has additive effect to the CORTISOL Excess that contributes to the Blood Sugar rise in Moms and Babies
- Glucocorticoids can be used during Pregnancy if the Mother has Asthma

11) ETHNIC GROUPS with HIGH Prevalence of T2DM
a) HISPANIC
b) AFRICAN AMERICAN
c) Native American
d) South or East Asian
e) Pacific Islander

Question 3

Terms for Abnormal Glucose in General Population

Answer 3

• Also known as “PRE-DIABETES” or “INTERMEDIATE HYPERGLYCEMIA”

1) IMPAIRED FASTING GLUCOSE (IFG)
- 100 to 125

2) IMPAIRED GLUCOSE TOLERANCE (IGT)
- 140 to 199
* ***After GLUCOSE CHALLENGE

Question 4

Screening for Gestational Diabetes Mellitus

Answer 4

• Two Step approach MOST COMMON in US:

1) Screen with 50 Grams ORAL GLUCOSE Challenge with Single PLASMA GLUCOSE drawn at ONE HOUR!!!
- Less than 130 is NORMAL!

2) If the First Screening was GREATER THAN 130, then proceed with 100 Gram ORAL GLUCOSE Challenge in a FASTING STATE (No Caloric Intake for at least 8 Hours PRIOR to Test)

• **100 Gram Challenge: 2 ELEVATED VALUES is a POSITIVE TEST for GDM:
  1) Fasting

Question 5

Fetal Growth from Gestational Diabetes Mellitus

Answer 5

1) Mother’s Blood brings EXTRA GLUCOSE to Fetus
2) Fetus makes MORE INSULIN to handle the Extra Glucose
3) Extra Glucose gets stored as FAT and Fetus becomes LARGER than NORMAL!!!

Question 6

Maternal Complications

Answer 6

1) STILLBIRTH
2) PREECLAMPSIA: New onset of HYPERTENSION (>140/ 90) and PROTEINURIA after 20 WEEK GESTATION

3) Babies that are large for Gestational Age (LGA) or MACROCOSMIC!!!!!!
- Can result in PERINEAL LACERATION in Vaginal Birth
- May prompt C-SECTION DELIVERY

4) HYDROMANIOS (Poly): EXCESS Amniotic Fluid in Uterus

Question 7

Increased Long Term Risk for Mother

Answer 7

• Type 2 Diabetes Mellitus
• T1 Diabetes Mellitus
• CARDIOVASCULAR DISEASE

Question 8

Fetal Complications

Answer 8

1) SHOULDER DYSTOCIA
2) BRACHIAL PELXUS INJURY

3) BIRTH TRAUMA
- Contusions
- Large HEMATOMA from Vacuum Extraction
- HYPOXIA/ ACIDOSIS

4) Increased Long Term risk of OBESITY and METABOLIC SYNDROME!!!!!!!!!!!!!!!

Question 9

Monitor Fetus Closely

Answer 9

1) Pre-Natal

2) Post-Natal
A) HYPOGLYCEMIA: SEVERE RISK (Right after Birth)!!!!!!!!!!!

B) HYPERBILIRUBINEMIA: Especially with Contusion or Hematoma (JAUNDICE)!!!!!!!!!!!!!!!!!!!