Gestational Diabetes Lecture Powerpoint

Question 1

Overt diabetes vs gestational

Answer 1

Overt is having known to have diabetes prior to pregnancy while gestational is diagnosed for the first time during pregnancy (and is the majority of cases)

Question 2

Diagnostic criteria of overt DM (3)

Answer 2

• random glucose >200
• fasting gluose >126
• HgB A1C greater than 6.5 twice 6 weeks apart

Question 3

Class A diabetic (and A1 and A2 subtypes)

Answer 3

-gestational in origin with no vascular disease, treated with therapeutic diet, oral agents, or insulin (A1 if diet only, fasting <95, A2 if meds needed for control, fasting >95) (note that its lower than in overt DM)

Question 4

Class B diabetic

Answer 4

Onset of overt diabetes after age 20 duration less than 10 years with no vascular disease prior to any pregnancy usually treated with insulin but glyburide and metformin as well

Question 5

If a mother has fasting hyperglycemia early in pregnancy it likely represents ___, while if it occurs later then it likely represents ___

Answer 5

overt DM, true gestational diabetes

Question 6

Screening for gestational diabetes

Answer 6

• Universal between 24-28 weeks, done uniquely with carbohydrate challenge***** (only time this is used to diagnose any type of diabetes) involving 50gm glucose load done randomly with threshold of 130 mg/dLl being nearly 90% predictive
• positive indicates confirmatory test, 100g 3 hour oral glucose tolerance test after overnight fast where plasma glucose fasting cannot exceed 95mg/dL, 1 hr 185, 2 165, etc.

Question 7

Gestational diabetes etiology (2)

Answer 7

• hPL stimulating insulin release, decreased glucose uptake and gluconeogensis causing mother to get progressively more insulin resistant
• PCOS can worsen

Question 8

Risk factors for gestational diabetes (6)

Answer 8

• previous history of gestational diabetes
• obesity
• age >30
• previous delivery of large infant
• persistent glycosuria
• family history of DM in first degree relative of many minority populations

Question 9

Fetal complications of gestational diabetes (3)

Answer 9

• fetal anomalies not increased in gestational diabetes unlike overt (congenital heart defects)
• stillbirth increased if there is fasting hyperglycemia but not with postprandial hyperglycemia only
• macrosomia (weight >90th percentile)

Question 10

Management of DM in pregnancy (5)

Answer 10

• diet
• exercise
• glyburide
• insulin (typically regular not long term like lantus)
• metformin

Question 11

Insulin requiring gesetational diabetics are managed with antenatal testing and usually delivered by…

Answer 11

….estimated date of delivery (normal range)

Question 12

More than half of gestational diabetics will ultimately develop….

Answer 12

….overt diabetes in the following 20 years

Question 13

Overt diabetes complications (4)

Answer 13

• fetal loss
• preterm labor
• malformations (heart, CNS, kidney, skeleton, situs inversus, anal atresia)
• uneplained fetal demise

Question 14

1 mechanism to lower congenital heart defects

Answer 14

Control blood sugar prior to conception

Question 15

Maternal risks of gestational diabetes (4)

Answer 15

• polyhydramnios
• C section
• infection
• preeclampsia/eclampsia

Question 16

Neonatal hypoglycemia

Answer 16

-blood glucose <30mg/dL that occurs when blood sugar goes up in infant when mother is poorly controlled diabetic becomes hyperinsulinemic due to hypertrophy of pancreatic tissue to comopensate resulting in low blood glucose which then requires NICU until stabilization and eventual return to normal

Question 17

Gestational DM diet

Answer 17

standard 1800kcal for mother and 300kcal additional for pregnancy

Question 18

If glycemic control is strict, women are at no higher risk than general population for….

Answer 18

…macrosomic infant

Question 19

Type 2 diabetes do not need insulin to prevent ketoacidosis but do need it to prevent…

Answer 19

….hyperosmotic coma