Gestational Diabetes Mellitus (GDM) Dynamed Flashcards
1
Q
What are the risk factors for gestational diabetes mellitus (GDM) mentioned in the notes?
A
The risk factors for GDM mentioned in the notes included pre-pregnancy BMI, previous GDM status, and weeks gestation at diagnostic oral glucose tolerance test, as well as ethnic group from Middle East or Southern Asia, family history of type 2 diabetes, body mass index ≥ 30 kg/m2 before pregnancy, previous child with macrosomia, and history of GDM or polycystic ovarian syndrome.
2
Q
What was the primary outcome measured in the RADIEL trial mentioned in the notes?
A
The primary outcome measured in the RADIEL trial was GDM at 24-28 weeks gestation, determined using oral glucose tolerance test.
3
Q
What were the outcomes compared between the lifestyle intervention group and standard antenatal care group in the randomized trial mentioned in the notes?
A
In the randomized trial, the outcomes compared between the lifestyle intervention group and the standard antenatal care group were GDM (33.3% vs. 57.5%; adjusted odds ratio 0.26, 95% CI 0.07-0.92, NNT 5), mean gestational weight gain (11.6 kg vs. 13.2 kg), and cesarean section (39% vs. 47%). There were no significant differences in neonatal outcomes, including birth weight and gestational age at delivery.
4
Q
What was the evidence mentioned for the use of metformin for prevention of GDM?
A
The notes mentioned evidence for the use of metformin for prevention of GDM, but the specific details were not provided.
5
Q
What is the initial diagnostic investigation for gestational diabetes mellitus (GDM) recommended by ACOG?
A
The initial diagnostic investigation recommended by ACOG is screening all pregnant patients at 24-28 weeks gestation for GDM with a laboratory-based test using blood glucose levels.
6
Q
What is the screening test for GDM recommended by ACOG?
A
The screening test for GDM recommended by ACOG is a 1-hour oral glucose tolerance test after a 50 g glucose load.
7
Q
What are the suggested thresholds for the 1-hour glucose screening test for GDM?
A
The suggested thresholds for the 1-hour glucose screening test for GDM are 130 mg/dL, 135 mg/dL, or 140 mg/dL, considering community prevalence of GDM and other factors.
8
Q
What are the diagnostic criteria for GDM based on the 100-g 3-hour oral glucose tolerance test?
A
The diagnostic criteria for GDM based on the 100-g 3-hour oral glucose tolerance test are fasting ≥ 95 mg/dL, 1-hour ≥ 180 mg/dL, 2-hour ≥ 155 mg/dL, and 3-hour ≥ 140 mg/dL.
9
Q
Why does ACOG not recommend the diagnosis of GDM based on the 1-step screening and diagnosis test?
A
ACOG does not recommend the diagnosis of GDM based on the 1-step screening and diagnosis test because there is a lack of evidence showing that using these criteria leads to clinically significantly improved outcomes.
10
Q
What is the 2-step approach to screening and diagnosis of GDM recommended by the Canadian Diabetes Association (CDA)?
A
The 2-step approach to screening and diagnosis of GDM recommended by the Canadian Diabetes Association (CDA) is a screening test consisting of a 1-hour 50 g nonfasting glucose challenge test; if plasma glucose ≥ 11.1 mmol/L (200 mg/dL), a 75 g oral glucose tolerance test is not required for diagnosis of GDM.
11
Q
What are the diagnostic criteria for GDM based on the 75-g oral glucose tolerance test in the 2-step approach recommended by CDA?
A
The diagnostic criteria for GDM based on the 75-g oral glucose tolerance test in the 2-step approach recommended by CDA are fasting plasma glucose ≥ 5.3 mmol/L, 1-hour plasma glucose ≥ 10.6 mmol/L, and 2-hour plasma glucose ≥ 9 mmol/L.
12
Q
What is the 1-step approach to the diagnosis of GDM recommended by the World Health Organization (WHO)?
A
The 1-step approach to the diagnosis of GDM recommended by the World Health Organization (WHO) is fasting plasma glucose ≥ 92 mg/dL (5.1 mmol/L) on initial prenatal testing and ≥ 1 of the following on the 2-hour 75-g oral glucose tolerance test: fasting plasma glucose ≥ 92 mg/dL (5.1 mmol/L), 1-hour plasma glucose ≥ 180 mg/dL (10 mmol/L), or 2-hour plasma glucose ≥ 153-199 mg/dL (8.5-11 mmol/L).
13
Q
What is the sensitivity of HbA1c measurement for detection of diabetes at ADA recommended cutoff?
A
The sensitivity of HbA1c measurement for detection of diabetes at ADA recommended cutoff of ≥ 6.5% is 19.4%.
14
Q
What is the specificity of HbA1c measurement for detection of diabetes at ADA recommended cutoff?
A
The specificity of HbA1c measurement for detection of diabetes at ADA recommended cutoff of ≥ 6.5% is 98%.
15
Q
What is the positive predictive value of HbA1c measurement for detection of diabetes at ADA recommended cutoff?
A
The positive predictive value of HbA1c measurement for detection of diabetes at ADA recommended cutoff of ≥ 6.5% is 35%.
16
Q
What is the negative predictive value of HbA1c measurement for detection of diabetes at ADA recommended cutoff?
A
The negative predictive value of HbA1c measurement for detection of diabetes at ADA recommended cutoff of ≥ 6.5% is 95.7%.
17
Q
What is the sensitivity of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4%?
A
The sensitivity of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4% is 41.2%.
18
Q
What is the specificity of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4%?
A
The specificity of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4% is 72.2%.
19
Q
What is the positive predictive value of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4%?
A
The positive predictive value of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4% is 63.7%.
20
Q
What is the negative predictive value of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4%?
A
The negative predictive value of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4% is 50.9%.
21
Q
What improvements were associated with a soy diet in patients with gestational diabetes mellitus?
A
A soy diet was associated with improved maternal fasting plasma glucose, serum insulin, triglycerides, and biomarkers of oxidative stress.
22
Q
What were the findings of the Cochrane review on probiotics in pregnant patients with gestational diabetes mellitus?
A
The Cochrane review found no significant differences in risk of hypertensive disorders, cesarean section, large-for-gestational age, and infant hypoglycemia when comparing probiotics vs. placebo.
23
Q
What were the findings of the randomized trial on magnesium supplementation in women with magnesium deficiency and gestational diabetes mellitus?
A
The randomized trial found that magnesium supplementation was associated with a reduced risk of newborn hyperbilirubinemia and hospitalization.
24
Q
What is the difference in glycemic control between 4 times-daily regimen and twice-daily regimen for GDM patients?
A
91.3% of patients achieved adequate glycemic control with the 4 times-daily regimen compared to 74.3% with the twice-daily regimen.
25
What is the relative risk of neonatal hyperbilirubinemia with the 4 times-daily regimen?
The relative risk of neonatal hyperbilirubinemia is 0.51 (95% CI 0.29-0.91) with the 4 times-daily regimen.
26
What are the perinatal complications analyzed in the largest trial of intensive treatment for GDM?
The perinatal complications analyzed were serious perinatal complications (perinatal death, shoulder dystocia, nerve palsy, and bone fracture), macrosomia, and preeclampsia.
27
What is the risk ratio for labor induction in the intensive management group?
The risk ratio for labor induction in the intensive management group is 1.33 (95% CI 1.13-1.57).
28
What is the difference in neonatal hypoglycemia between intensive management and routine care?
There is no significant difference in neonatal hypoglycemia between intensive management and routine care.
29
What is the prevalence range of gestational diabetes mellitus (GDM) depending on the population and diagnostic test?
The prevalence range of GDM is 1%-14% depending on the population and diagnostic test.
30
What is the prevalence of GDM based on body mass index (BMI) categories?
The prevalence of GDM based on BMI categories is:
- Patients with underweight (BMI 13-18.4 kg/m2): 0.7%.
- Patients with normal weight (BMI 18.5-24.9 kg/m2): 2.3%.
- Patients with overweight (BMI 25-29.9 kg/m2): 4.8%.
- Patients with obesity (BMI 30-34.9 kg/m2): 5.5%.
- Patients with severe obesity (BMI 35-64.9 kg/m2): 11.5%.
31
Which racial/ethnic groups in the United States tend to have a higher prevalence of diabetes?
The racial/ethnic groups in the United States with a higher prevalence of diabetes are:
- Latinas.
- Native Americans.
- Asian Americans.
- African Americans.
- Pacific Islanders.
32
What is the prevalence of glucokinase monogenic diabetes in pregnant patients and patients with GDM?
The prevalence of glucokinase monogenic diabetes is 0.11% in pregnant patients and 0.93% in patients with GDM.
33
What is the association between twin pregnancies and gestational diabetes?
Twin pregnancies are associated with an increased risk of developing gestational diabetes.
34
What is the odds ratio for twin pregnancies developing gestational diabetes?
The odds ratio for twin pregnancies developing gestational diabetes is 2.2 (95% CI 1.4-3.6).
35
What is the association between polycystic ovary syndrome (PCOS) and maternal and neonatal complications?
PCOS is associated with an increased risk for preterm delivery, preeclampsia, and gestational diabetes.
36
What is the association between PCOS and preterm delivery?
PCOS is associated with an increased risk of preterm delivery with an odds ratio of 2.2 (95% CI 1.6-3).
37
What is the association between PCOS and preeclampsia?
PCOS is associated with an increased risk of preeclampsia with an odds ratio of 4.2 (95% CI 2.8-6.5).
38
What is the association between PCOS and gestational diabetes?
PCOS is associated with an increased risk of gestational diabetes with an odds ratio of 2.8 (95% CI 1.9-4).
39
What is the association between PCOS and infants being small-for-gestational-age?
Infants born to mothers with PCOS have an increased risk of being small-for-gestational-age with an odds ratio of 2.62 (95% CI 1.35-5.1).
40
What are the associations between PCOS and cesarean delivery, operative vaginal delivery, and birth of large-for-gestational-age infants?
There are no significant associations between PCOS and cesarean delivery, operative vaginal delivery, and birth of large-for-gestational-age infants.
41
What is the association between PCOS and hypertensive disorders in pregnancy?
PCOS is associated with an increased risk of hypertensive disorders in pregnancy.
42
What is the association between vitamin D insufficiency during pregnancy and gestational diabetes mellitus?
Vitamin D insufficiency during pregnancy is associated with an increased risk of gestational diabetes mellitus.
43
What was the percentage increase for transfusion of any blood product from 2014 to 2020?
The percentage increase for transfusion of any blood product from 2014 to 2020 was 8%.
44
What is the odds ratio for developing GDM in the second pregnancy for individuals with a history of GDM?
The odds ratio for developing GDM in the second pregnancy for individuals with a history of GDM is 13.2 (95% CI 12-14.6).
45
What is the odds ratio for developing GDM in the third pregnancy for individuals with GDM in the first two pregnancies?
The odds ratio for developing GDM in the third pregnancy for individuals with GDM in the first two pregnancies is 25.9 (95% CI 17.4-38.4).
46
What percentage of individuals with a history of GDM had GDM in their subsequent pregnancy?
35.6% of individuals with a history of GDM had GDM in their subsequent pregnancy.
47
What is the increased risk of developing type 2 diabetes for individuals with a history of GDM compared to those with a previously normoglycemic pregnancy?
Individuals with a history of GDM have an overall relative risk of 9.51 (95% CI 7.14-12.67) for developing type 2 diabetes compared to those with a previously normoglycemic pregnancy.
48
What is the prevalence of any postpartum glucose abnormality in patients with GDM?
The overall prevalence of any postpartum glucose abnormality in patients with GDM is 42%.
49
What were the neonatal complications observed in the glyburide vs. insulin study?
The study observed neonatal complications in 27.6% of patients on glyburide and 23.4% of patients on insulin.
50
What adverse neonatal outcomes were associated with glyburide compared to insulin?
Glyburide was associated with increased risk of neonatal intensive care unit admission, respiratory distress, and being large for gestational age.
51
Was there a significant difference in the risk of hypoglycemia and birth injury between glyburide and insulin?
No, there was no significant difference in the risk of hypoglycemia and birth injury between glyburide and insulin.
52
What were the recommended maternal capillary glucose goals for GDM during fasting and postprandial periods?
For fasting, the goal was ≤ 95 mg/dL (5.3 mmol/L). For 1-hour postprandial, the goal was ≤ 140 mg/dL (7.8 mmol/L). For 2-hour postprandial, the goal was ≤ 120 mg/dL (6.7 mmol/L).
53
What is the recommended blood glucose level for patients on insulin therapy?
For patients on insulin therapy, the blood glucose level should be maintained above 3.7 mmol/L (67 mg/dL).
54
According to a cohort study, what adverse outcomes are significantly associated with GDM-2 compared to no GDM?
GDM-2 is associated with significantly increased risk of preeclampsia and eclampsia, preterm delivery, and primary cesarean delivery.
55
What is the definition of macrosomia in the context of birth weight?
Macrosomia refers to birth weight greater than 4 kg (8.82 lbs).
56
What were the lower plasma glucose criteria for the diagnosis of gestational diabetes?
The lower plasma glucose criteria for the diagnosis of gestational diabetes were glucose levels ≥ 92 mg/dL fasting, ≥ 180 mg/dL at 1 hour, or ≥ 153 mg/dL at 2 hours.
57
What percentage of patients were diagnosed with gestational diabetes using the lower glucose criteria?
15.3% of patients were diagnosed with gestational diabetes using the lower glucose criteria.
58
What is the definition of gestational diabetes mellitus (GDM)?
Gestational diabetes mellitus (GDM) refers to glucose intolerance diagnosed for the first time in pregnancy and not meeting the criteria for type 2 diabetes.
59
What are the risk factors for the development of GDM?
The risk factors for the development of GDM include obesity, personal history of prior GDM or glucose intolerance, strong family history of type 2 diabetes, and multiple gestation.
60
What are the potential complications for infants of mothers with maternal hyperglycemia?
Infants of mothers with maternal hyperglycemia are at risk for stillbirth, shoulder dystocia and brachial plexus injury, neonatal complications such as hypoglycemia and hyperbilirubinemia, and increased fetal growth.
61
How should GDM be evaluated in pregnant women?
Many professional organizations recommend that all pregnant women should be screened for GDM at 24-28 weeks gestation with a laboratory-based test using blood glucose levels. Earlier testing may be indicated for women at high risk.
62
What are the two approaches for screening and diagnosing GDM?
The two approaches for screening and diagnosing GDM are the 2-step approach and the 1-step approach.
63
What is the recommended screening approach for GDM according to ACOG practice bulletin?
ACOG practice bulletin states that the diagnosis of GDM based on 1-step screening and diagnosis test (75-g 2-hour oral glucose tolerance testing) is not recommended because there is no evidence that using this criteria leads to clinically significantly improved outcomes.
64
What is the initial management approach for GDM?
The initial management of GDM should include counseling on diet and exercise with addition of medications if needed.
65
What are the target plasma glucose levels for women with GDM?
The suggested target plasma glucose levels for women with GDM include fasting ≤ 95 mg/dL (5.3 mmol/L), 1 hour post meal ≤ 140 mg/dL (7.8 mmol/L), and 2 hours post meal ≤ 120 mg/dL (6.7 mmol/L).
66
What is the definition of normal blood pressure in the context of gestational diabetes?
Normal blood pressure in the context of gestational diabetes is < 120/80 mm Hg.
67
What is the definition of prehypertension in the context of gestational diabetes?
Prehypertension in the context of gestational diabetes is defined as blood pressure between 120-139/80-89 mm Hg.
68
What is the definition of hypertension in the context of gestational diabetes?
Hypertension in the context of gestational diabetes is defined as systolic blood pressure ≥ 140 mm Hg OR diastolic blood pressure ≥ 90 mm Hg OR the use of antihypertensive medications.
69
What is the increased risk of gestational diabetes for individuals with a history of hypertension?
For individuals with a history of hypertension, the odds ratio (OR) for increased risk of gestational diabetes is 2.01, with a 95% confidence interval (CI) of 1.01-3.99.
70
What is the prevalence of gestational diabetes in patients with cystic fibrosis?
In a small cohort study, gestational diabetes was reported in 7 out of 8 pregnant patients with cystic fibrosis.
71
What are some of the factors that were not significantly different between patients treated with 500 units/mL concentrated insulin and patients treated with conventional insulin therapy?
The factors that were not significantly different between the two groups include mean fasting glucose, postprandial glucose, and HbA1c.
72
Was treatment with 500 units/mL concentrated insulin associated with improved pregnancy outcomes or glycemic control?
No, treatment with 500 units/mL concentrated insulin was not associated with improved pregnancy outcomes or glycemic control.
73
What was the rate of blood glucose values < 60 mg/dL (1,081 mmol/L) for patients treated with concentrated insulin compared to conventional therapy?
The rate of blood glucose values < 60 mg/dL (1,081 mmol/L) was 4.8% with concentrated insulin compared to 2.4% with conventional therapy.
74
What are the suggested insulin management recommendations during labor for patients with gestational diabetes?
During labor, the suggested insulin management recommendations include giving the usual dose of intermediate-acting or long-acting insulin at bedtime, withholding or reducing the morning dose of insulin based on admission and delivery timing, and administering short-acting regular insulin IV infusion if glucose levels exceed 100 mg/dL (5.55 mmol/L).
75
What is the recommended range for maintaining maternal blood glucose levels during labor in women with gestational diabetes?
The recommended range for maintaining maternal blood glucose levels during labor in women with gestational diabetes is between 4 mmol/L (72 mg/dL) and 7 mmol/L (126 mg/dL).
76
Why is maintaining blood glucose levels below 110 mg/dL (6.1 mmol/L) during labor important?
Maintaining blood glucose levels below 110 mg/dL (6.1 mmol/L) during labor may help prevent fetal hyperglycemia and decrease the likelihood of subsequent neonatal hypoglycemia.
77
What is the definition of conventional management in the context of fetal growth assessment?
Conventional management refers to metabolic management (diet and insulin, if needed) as guided by preprandial and postprandial capillary blood glucose measurements.
78
What is the definition of ultrasound-guided management in the context of fetal growth assessment?
Ultrasound-guided management refers to metabolic management guided by the presence of accelerated fetal growth.
79
What were the outcomes associated with ultrasound-guided management compared to conventional management in the trials?
Ultrasound-guided management was associated with decreased large for gestational age, decreased abnormal birth weight, decreased macrosomia ≥ 4,000 g, and increased insulin treatment.
80
Were there any significant differences observed in cesarean section rates between ultrasound-guided management and conventional management?
No significant differences were observed in cesarean section rates between the two management approaches.
81
According to the ADA, what lifestyle interventions are recommended for patients with blood pressure > 120/80 mmHg?
For patients with blood pressure > 120/80 mmHg, the ADA recommends lifestyle interventions such as weight loss if overweight or obese, a DASH-style eating pattern (reducing sodium and increasing potassium intake), and increased physical activity.
82
What blood pressure targets are suggested for patients with diabetes and chronic hypertension during pregnancy?
For patients with diabetes and chronic hypertension during pregnancy, a systolic blood pressure target of 110-135 mmHg and diastolic blood pressure of 85 mmHg is suggested to reduce the risk of accelerated maternal hypertension and minimize impaired fetal growth.
83
Which medications should be avoided in sexually active patients of childbearing age who are not using reliable contraception?
Potentially harmful medications in pregnancy, including ACE inhibitors, angiotensin receptor blockers, and statins, should be stopped at conception and avoided in sexually active patients of childbearing age who are not using reliable contraception.
84
Why should statins continue to be avoided in pregnancy in most patients?
Statins should continue to be avoided in pregnancy in most patients due to their potential to reduce cholesterol synthesis and the inability to rule out fetal harm.
85
What are some adverse neonatal outcomes associated with gestational diabetes mellitus?
Some adverse neonatal outcomes associated with gestational diabetes mellitus include elevated cord-blood C-peptide level, birth trauma, infant small for gestational age, preterm delivery, admission to neonatal intensive care unit, IV glucose treatment, and respiratory distress syndrome.
86
What were the inclusion criteria for the randomized trial?
The inclusion criteria for the randomized trial were adult patients with singleton pregnancy between 4 and 19 6/7 weeks gestation, gestational diabetes mellitus diagnosed on oral glucose tolerance test, and at least one risk factor for hyperglycemia.
87
According to the Endocrine Society, what is the recommended postpartum screening for hyperglycemia?
The Endocrine Society recommends measurement of fasting plasma glucose or fasting self-monitored blood glucose for 24-72 hours after delivery to rule out ongoing hyperglycemia.
88
How long should insulin requirements be evaluated and adjusted postpartum?
Insulin requirements should be evaluated and adjusted as needed for the initial few days postpartum as they are often about half the prepregnancy requirement.
89
What are the American Diabetes Association (ADA) recommendations for postpartum screening in patients with gestational diabetes mellitus (GDM)?
The ADA recommends screening for persistent diabetes at 4-12 weeks postpartum using 75-g 2-hour oral glucose tolerance testing (OGTT) and nonpregnancy diagnostic criteria.
90
What should be done if a patient with gestational diabetes mellitus (GDM) is found to have prediabetes?
Intensive lifestyle interventions and/or metformin should be provided to prevent diabetes in patients with overweight or obesity who have a history of GDM and are found to have prediabetes.
91
What are the recommendations regarding breastfeeding for patients with gestational diabetes mellitus (GDM)?
Patients with GDM should be encouraged to breastfeed immediately after delivery to avoid neonatal hypoglycemia. Breastfeeding for ≥ 3-4 months postpartum is recommended to help prevent childhood obesity, prevent diabetes in offspring, and reduce the risk of maternal type 2 diabetes and hypertension.
92
What contraceptive methods are recommended for patients with diabetes of reproductive potential?
For patients with diabetes of reproductive potential, nonhormonal methods, low-dose combination oral contraceptives (wait 6-8 weeks if breastfeeding), and progesterone-only methods (used with caution during breastfeeding due to a possible increase in diabetes risk) can be used.
93
What are the risks associated with gestational diabetes?
The risks associated with gestational diabetes include increased risk of infant large for gestational age, macrosomia, preterm delivery, low 1-minute Apgar score, and neonatal jaundice.
94
What are the risks associated with gestational diabetes in studies with insulin use?
The risks associated with gestational diabetes in studies with insulin use include increased risk of admission to neonatal intensive care unit, respiratory distress syndrome, infant large for gestational age, neonatal jaundice, and a nonsignificant increase in preterm delivery and macrosomia.
95
According to ADA recommendations, when should pregnant patients at high-risk for abnormal glucose metabolism be screened for gestational diabetes mellitus (GDM)?
Pregnant patients at high-risk for abnormal glucose metabolism should be screened for GDM between 24-28 weeks gestation.
96
What are the diagnostic criteria for GDM according to the '1-step' approach recommended by the International Association of Diabetes and Pregnancy Study Group (IADPSG)?
The diagnostic criteria for GDM according to the '1-step' approach recommended by IADPSG are: fasting plasma glucose ≥ 92 mg/dL (5.1 mmol/L), 1-hour plasma glucose ≥ 180 mg/dL (10 mmol/L), and 2-hour plasma glucose ≥ 153 mg/dL (8.5 mmol/L).
97
What are the diagnostic criteria for GDM according to the '2-step' approach recommended by the American College of Obstetricians and Gynecologists (ACOG)?
The diagnostic criteria for GDM according to the '2-step' approach recommended by ACOG are based on the Carpenter and Coustan criteria.
98
According to ADA recommendations, when should postpartum screening for persistent diabetes be conducted in patients with GDM?
Postpartum screening for persistent diabetes should be conducted at 4-12 weeks postpartum.
99
What are the nonpregnancy diagnostic criteria for postpartum screening in patients with GDM according to ADA recommendations?
The nonpregnancy diagnostic criteria for postpartum screening in patients with GDM according to ADA recommendations are: fasting plasma glucose ≥ 126 mg/dL (7 mmol/L) or 2-hour plasma glucose ≥ 200 mg/dL (11.1 mmol/L).
100
According to ADA recommendations, how often should patients with a history of GDM be screened for type 2 diabetes or prediabetes?
Patients with a history of GDM should undergo lifelong screening for type 2 diabetes or prediabetes every 1-3 years.
101
What does the United States Preventive Services Task Force (USPSTF) recommend regarding screening for GDM?
The USPSTF recommends screening for GDM in asymptomatic pregnant patients after 24 weeks of gestation.
102
What is the specificity of the 50-g glucose challenge test for detecting GDM before 32 weeks gestation using a threshold of 7.8 mmol/L (140 mg/dL) in women with risk factors for GDM?
The specificity is 77% (95% CI 66%-89%).
103
Did exercise training during pregnancy reduce glucose levels, GDM, or birth weight in patients with overweight or obesity at risk for GDM?
Exercise training during pregnancy did not reduce glucose levels, GDM, or birth weight in patients with overweight or obesity at risk for GDM.
104
What is the relationship between physical activity before pregnancy and the risk of GDM?
Physical activity before pregnancy is associated with a reduced risk of GDM.
105
What is the relationship between physical activity during early pregnancy and the risk of GDM?
Physical activity during early pregnancy is associated with a reduced risk of GDM.
106
What does the Cochrane Review suggest about the combined effect of diet and exercise during pregnancy on the risk of GDM?
The Cochrane Review suggests that the combination of diet and exercise during pregnancy might reduce the risk of GDM, although the reduction is nonsignificant.
107
According to DynaMed Level 3, what is the potential benefit of insulin therapy in patients with GDM?
insulin therapy may reduce fetal macrosomia
108
According to DynaMed Level 2, what type of glucose monitoring is associated with better glycemic control and improved perinatal outcomes in insulin therapy?
postprandial glucose monitoring
109
Based on DynaMed Level 2, how do oral hypoglycemics and insulin compare in terms of pregnancy outcomes in GDM patients?
They appear to have similar pregnancy outcomes
110
What does ACOG Level C recommend for patients with GDM and estimated fetal weight of ≥ 4,500 g?
counsel patients about the risks and benefits of scheduled cesarean delivery
111
According to Canadian Diabetes Association recommendations, when should labor induction be offered to patients with GDM?
between 38 and 40 weeks gestation
112
Does labor induction reduce rates of cesarean delivery, macrosomia, and shoulder dystocia in patients with GDM and term pregnancies?
No, induction may not reduce rates of cesarean delivery, macrosomia, and shoulder dystocia
113
Based on the randomized trial mentioned in BJOG 2017, what is the approximate cesarean section rate in patients with GDM undergoing labor induction?
around 12.65%
114
Is there a significant difference in the cesarean delivery rate between labor induction and expectant management in patients with GDM?
No, there is no significant difference in the cesarean delivery rate
115
How many infants were included in the analysis for neonatal hypoglycemia?
586
116
When should initial screening for gestational diabetes be performed?in patients at risk of undiagnosed type 2 diabetes
Initial screening should be performed before 20 weeks gestation.
117
If the initial screening for gestational diabetes is negative, when should a rescreen be done?
If the initial screening is negative, a rescreen should be done between 24-28 weeks gestation.
118
What are some risk factors for gestational diabetes?
Some risk factors for gestational diabetes include family history of diabetes, maternal age ≥ 30 years, excessive weight gain, obesity, previous gestational diabetes or pregnancy-induced hypertension, fetal anomaly, intrauterine fetal death, macrosomia, polyhydramnios, glycosuria, or polydipsia.
119
What percentage of patients did not complete the randomized trial on GDM?
30.7% of patients did not complete the trial, with 22.8% lost to follow-up and excluded from analyses.
120
Based on the cohort study, what dietary pattern adherence was associated with a decreased risk of type 2 diabetes in patients with a history of GDM?
The alternate Healthy Eating Index dietary pattern adherence was associated with a decreased risk of type 2 diabetes.
121
What are some other causes of hyperglycemia?
Some other causes of hyperglycemia include certain medications (corticosteroids, olanzapine, antiretrovirals), stress-related factors, endocrine disorders (Cushing syndrome, acromegaly, etc.), and pancreatic insufficiency.
122
What are the blood tests used for diagnosing and monitoring gestational diabetes mellitus?
The blood tests used for diagnosing and monitoring GDM include the oral glucose tolerance test (OGTT), plasma or serum glucose levels, and HbA1c levels.
123
Is routine urine ketone testing recommended for gestational diabetes mellitus?
No, routine urine ketone testing is not recommended for GDM. It should only be considered in patients with overt diabetes or suspected diabetic ketoacidosis.
124
What imaging studies can be done for gestational diabetes mellitus?
Amniotic fluid levels can be measured as part of standard second and third-trimester ultrasound, and monitoring of fetal growth can be done with serial ultrasound measurements after the diagnosis of GDM.
125
According to the Cochrane review, how does supplementation with vitamin D > 600 units/day compare to lower doses in reducing the risk of gestational diabetes?
Supplementation with vitamin D > 600 units/day may reduce the risk of gestational diabetes compared to lower doses.
126
What is the risk ratio of gestational diabetes with vitamin D > 600 units/day compared to ≤ 600 units/day alone or in combination with other supplements?
The risk ratio of gestational diabetes with vitamin D > 600 units/day compared to ≤ 600 units/day alone or in combination with other supplements is 0.54 (95% CI 0.34-0.86).
127
Is there a significant difference in the risk of gestational diabetes between vitamin D ≥ 4,000 units/day and < 4,000 units/day alone?
No, there is no significant difference in the risk of gestational diabetes between vitamin D ≥ 4,000 units/day and < 4,000 units/day alone (risk ratio 0.89, 95% CI 0.56-1.42).
128
What is the conclusion regarding probiotics and the risk of developing GDM according to the Cochrane review?
There is conflicting evidence for probiotics and the risk of developing GDM.
129
What did the Cochrane review of trials comparing different glucose monitoring methods or settings in patients with GDM find?
The Cochrane review found that continuous glucose monitoring might be associated with a reduced risk of large-for-gestational age, but similar risks of cesarean section and neonatal hypoglycemia compared to self-monitoring in patients with GDM.
130
What were the telemedicine interventions compared to standard care in patients with GDM?
The telemedicine interventions included WeChat, web-based systems, health devices allowing uploading of data to provide feedback to patients, and health apps.
131
Did the randomized trial comparing metformin vs. insulin show any significant differences in birth weight?
No, the randomized trial comparing metformin vs. insulin did not show any significant differences in birth weight.
132
What were the risks associated with glibenclamide (glyburide) according to the systematic review of randomized trials?
The risks associated with glibenclamide (glyburide) according to the systematic review of randomized trials were increased risk of macrosomia, neonatal hypoglycemia, and increased birth weight.
133
Did the systematic review show any significant differences in preterm birth between glibenclamide and metformin?
No, the systematic review did not show any significant differences in preterm birth between glibenclamide and metformin.
134
How was the noninferiority of glyburide defined in the trial comparing glyburide and insulin?
The noninferiority of glyburide was defined as a rate of neonatal complications less than 9% higher than with insulin at the limit of 97.5% for difference.
135
Was there a significant difference in the composite infant outcome between the Mediterranean-style diet and usual care groups?
No, there was not a significant difference in the composite infant outcome between the Mediterranean-style diet and usual care groups.
136
What was the conclusion of the Cochrane review on exercise interventions for prevention of GDM?
The addition of exercise to routine antenatal care does not appear to reduce the risk of gestational diabetes.
137
Does glucose control decrease neonatal glucose within the first 24 hours after birth?
Yes, glucose control may slightly decrease neonatal glucose within the first 24 hours after birth.
138
Does glucose control increase neonatal hypoglycemia in patients with GDM?
No, glucose control may not increase neonatal hypoglycemia compared to liberalized control in patients with GDM.
139
What are the findings of the Cochrane Database Syst Rev study?
The study suggests that early labor induction at 38 weeks gestation and expectant management have similar rates of cesarean delivery and maternal and neonatal morbidity in patients with insulin-requiring GDM.
140
What are the findings of the Wien Klin Wochenschr randomized trial?
The trial found that labor induction at 38 weeks gestation is associated with a higher incidence of newborn hypoglycemia (< 35 mg/dL) compared to induction at 40 weeks gestation. However, the rates of large-for-gestational age newborns, successful delivery, and cesarean delivery were not significantly different.
141
When should women with GDM and an estimated fetal weight ≥ 4,500 g be counseled regarding mode of delivery?
Women with GDM and an estimated fetal weight ≥ 4,500 g should be counseled regarding mode of delivery.
142
Is there an evidence-based recommendation for the timing of delivery in women with well-controlled GDM?
No evidence-based recommendation is available for the timing of delivery in women with GDM that is well-controlled with either diet or medication.
143
When should screening for persistent diabetes be done postpartum in women with GDM?
Screen for persistent diabetes at 4-12 weeks postpartum.
144
What diagnostic criteria should be used for screening for persistent diabetes postpartum?
Screen for persistent diabetes using 75-g 2-hour oral glucose tolerance testing and nonpregnancy diagnostic criteria (fasting plasma glucose ≥ 126 mg/dL [7 mmol/L] or 2-hour plasma glucose ≥ 200 mg/dL [11.1 mmol/L]).
145
According to the AHRQ Evidence Report from 2008, what were the findings when comparing glyburide to insulin?
Insulin was associated with a small nonsignificant reduction in infant birth weight, while there was no significant difference in maternal glucose control.
146
According to the studies reviewed in DynaMed, how do metformin and insulin compare in terms of glycemic control?
Metformin and insulin appear equally effective for glycemic control.
147
What were the associations observed with metformin usage in patients with GDM, according to the systematic review in PLoS One in 2013?
Metformin was associated with an increased preterm birth, reduced pregnancy induced hypertension, reduced mean gestational age at birth, and reduced maternal weight gain.
148
Were there any significant differences observed between metformin and insulin in terms of mean fasting glycemic levels?
No significant differences were observed in mean fasting glycemic levels.
149
Was there a significant difference in perinatal outcomes between earlier treatment initiation and usual care in the randomized trial?
No significant interaction between timing of treatment initiation and treatment group for any perinatal outcomes
150
What type of insulin injection therapy is recommended?
Basal-bolus insulin injection therapy
151
Which rapid-acting insulin analogs may be used over regular insulin for postprandial glucose control?
Insulin aspart, lispro, or glulisine
152
What is the starting dose of bedtime NPH insulin for elevated fasting glucose levels?
0.2 units/kg body weight subcutaneously
153
In the randomized trial, did insulin therapy reduce fetal macrosomia in patients with GDM?
Insulin therapy may reduce fetal macrosomia in patients with GDM
154
What were the outcomes of the randomized trial on higher dose of insulin 4 times daily vs lower dose of insulin twice daily for glycemic control?
Higher dose of insulin 4 times daily may be more effective, decreasing risk of neonatal hypoglycemia and jaundice in newborns
155
Is there a significant difference in macrosomia rates between diet alone and diet plus insulin in patients with GDM?
Significant reductions in macrosomia rate were observed in patients treated with insulin
156
What is the net placental transfer of glyburide?
The net placental transfer of glyburide is reported to be about 70% of maternal levels.
157
Is glyburide recommended as a first-line option for patients with GDM?
No, glyburide is not recommended as a first-line option for patients with GDM.
158
In which patients may glyburide be considered?
Glyburide may be considered in patients who decline insulin and do not tolerate or are inadequately controlled on metformin.
159
What are the potential risks associated with glyburide?
Glyburide may be associated with an increased risk of neonatal hypoglycemia and macrosomia.
160
According to a randomized trial, is glyburide more effective than metformin for achieving glycemic control in patients with GDM?
According to a randomized trial, glyburide appears to be more effective than metformin for achieving glycemic control in patients with GDM.
161
Does the addition of glyburide to diet therapy in patients with mild GDM result in reduced birth weight or improved maternal or neonatal outcomes?
No, the addition of glyburide to diet therapy in patients with mild GDM is not associated with reduced birth weight or improved maternal or neonatal outcomes.
162
What is the preferred treatment for gestational diabetes mellitus (GDM)?
Insulin
163
What are the second-line pharmacological treatment options for GDM?
Metformin and glyburide
164
Under what circumstances is metformin a reasonable alternative first-line choice for GDM?
If the patient declines insulin therapy or is unable to safely administer insulin
165
Is glyburide recommended as a first-line option for GDM?
No
166
When should metformin be discontinued if used to induce ovulation in patients with polycystic ovary syndrome?
By the end of the first trimester
167
What are the benefits of treatment for GDM?
Reduced risk of adverse neonatal outcomes
168
Which outcomes are interventions for GDM associated with a reduced risk of?
Shoulder dystocia, macrosomia, large for gestational age, neonatal intensive care unit admissions, birth injuries, and primary cesarean delivery
169
Are there significant differences in preterm birth, small for gestational age, neonatal mortality, respiratory distress syndrome, neonatal hypoglycemia, hyperbilirubinemia, hypertensive disorders in pregnancy, preeclampsia, or total cesarean deliveries in the analysis?
No
170
What is the prevalence of GCK-MODY in patients with GDM?
The prevalence of GCK-MODY is 0.93% in patients with GDM.
171
What are some likely risk factors for gestational diabetes mellitus (GDM)?
Some likely risk factors for GDM include increased risk of type 2 diabetes in adults with overweight or obesity, first-degree relative with diabetes, high-risk race/ethnicity, history of cardiovascular disease, hypertension, low HDL cholesterol level, high triglyceride level, polycystic ovary syndrome, physical inactivity, and other clinical conditions associated with insulin resistance.
172
What are some additional factors associated with high risk for GDM?
Some additional factors associated with high risk for GDM include advanced maternal age, previous history of GDM, impaired glucose metabolism, or glucosuria.
173
What factors were found to be increased in patients with GDM compared to those without GDM?
In a systematic review, factors that were found to be increased in patients with GDM compared to those without GDM include history of previous GDM, history of macrosomia, history of congenital anomalies, body mass index ≥ 25 kg/m2, pregnancy-induced hypertension, family history of diabetes, history of stillbirth, polycystic ovary syndrome, history of abortion, history of preterm delivery, and multiparity.
174
What is the association between rate of gestational weight gain and GDM?
Based on two case-control studies, a rate of weight gain ≥ 0.41 kg/week (0.89 lb/week) is associated with an increased risk of GDM.
175
What is the correction for a study regarding gestational weight gain and GDM?
The correction for the study can be found in Obstet Gynecol 2010 May;115(5):1092.
176
What is the association between maternal gestational diabetes mellitus (GDM) and the risk of overweight in offspring at 1-5 years of age?
Maternal GDM with prepregnancy obesity or excessive gestational weight gain is associated with an increased risk of overweight in offspring at 1-5 years of age.
177
According to the cohort study, what is the overall incidence of overweight in children born to mothers with GDM compared to those without GDM?
The overall incidence of overweight in children born to mothers with GDM is 16.6% compared to 12.6% in children born to mothers without GDM.
178
According to the cohort study, what is the percentage difference in insulin level between children with a history of maternal GDM and those without?
The percentage difference in insulin level between children with a history of maternal GDM and those without is 10.9%.
179
Is there consistent evidence for the association between GDM and risk of obesity in childhood?
No, there is conflicting evidence for the association between GDM and risk of obesity in childhood.
180
Is there a significant association between maternal GDM and offspring BMI z score after adjusting for maternal prepregnancy BMI?
No, there is no significant association between maternal GDM and offspring BMI z score after adjusting for maternal prepregnancy BMI.
181
What is the threshold level for glucose in the 2-step glucose tolerance test?
The threshold level for glucose in the 2-step glucose tolerance test is ≥ 140 mg/dL [7.8 mmol/L].
182
What are the potential benefits of treating GDM?
Decreased risk of preeclampsia, large for gestational age infant, shoulder dystocia
183
In the randomized trial for insulin treatment in patients with GDM, how many patients were included in the intention-to-treat analyses?
All patients were included in the intention-to-treat analyses.
184
What is the relationship between high protein or low carbohydrate diet and gestational diabetes mellitus in Chinese patients?
High protein or low carbohydrate diet in pregnancy may be associated with an increased risk of gestational diabetes mellitus compared to a low protein or high carbohydrate diet in Chinese patients.
185
What is the association between higher fish-eggs-meat consumption and gestational diabetes mellitus in Chinese patients?
Higher fish-eggs-meat consumption is associated with an increased risk of gestational diabetes mellitus compared to lower fish-eggs-meat consumption.
186
What is the association between higher rice-wheat-fruits consumption and gestational diabetes mellitus in Chinese patients?
Higher rice-wheat-fruits consumption is associated with a decreased risk of gestational diabetes mellitus compared to lower rice-wheat-fruits consumption.
187
What is the association between higher consumption of animal protein and gestational diabetes mellitus in Asian patients?
Higher consumption of animal protein may be associated with an increased risk of gestational diabetes mellitus in Asian patients.
188
According to the DynaMed systematic review, what can treatment for GDM decrease the risk of?
Large for gestational age, shoulder dystocia, and preeclampsia
189
Did acarbose or insulin show significant differences in cesarean delivery rates, neonatal hypoglycemia, and birth weight?
No significant differences were observed in cesarean delivery rates, neonatal hypoglycemia, or birth weight between acarbose and insulin.
190
What is the definition of gestational age?
Gestational age is defined as standardized birth weight > 90th percentile.
191
What is the definition of small for gestational age?
Small for gestational age is defined as < 10th percentile.
192
What is the recommended target for HbA1c in pregnancy?
The recommended target for HbA1c in pregnancy is < 6% (42 mmol/mol) if achievable without significant hypoglycemia.
193
When should fetal surveillance be considered in patients with gestational diabetes?
Fetal surveillance should be considered starting at 32 weeks gestation for patients with poorly controlled GDM or GDM that requires medication.
194
What are some factors associated with increased risk of adverse pregnancy outcomes that may require fetal surveillance before 32 weeks gestation in patients with GDM?
Other factors associated with increased risk of adverse pregnancy outcomes may include poorly controlled GDM or comorbidities.
195
What does the Canadian Diabetes Association recommend regarding increased frequency of fetal assessment in patients with GDM?
They recommend that increased frequency of fetal assessment should be considered in patients with poorly controlled GDM or associated with comorbidities.
196
What did the Acta Obstet Gynecol Scand systematic review find regarding ultrasound-guided management in patients with GDM?
Ultrasound-guided management appears to improve fetal growth outcomes in patients with GDM.
197
Did the Cochrane review find a significant difference in the incidence of preeclampsia when comparing the DASH diet to the control diet?
No
198
Were there any significant differences in the incidence of large for gestational age or cesarean section when comparing a low-moderate glycemic index diet to a moderate-high glycemic index diet?
No
199
Based on the Cochrane review, was there sufficient evidence to determine the optimal diet for patients with GDM?
No
200
In the Cochrane review, were there any significant differences in macrosomia and large for gestational age when comparing a low-to-moderate glycemic index diet to a moderate-to-high glycemic index diet?
No
201
Did the high-monosaturated-fat diet have a significant effect on neonatal outcomes in the trial with 27 women?
No
202
What was the effect of the high-monosaturated-fat diet on maternal body mass index in late pregnancy and at 6-9 months postpartum?
Increased
203
What is the average weight gain in pounds with normal glucose tolerance?
11.2 lbs (5.1 kg)
204
What is the average weight gain in pounds with diet-controlled GDM?
15.3 lbs (6.9 kg)
205
What is the average weight gain in pounds with insulin-requiring GDM?
14.6 lbs (6.6 kg)
206
What were the effects of magnesium supplementation on fasting plasma glucose and serum insulin concentration compared to placebo at 6 weeks?
Decreased fasting plasma glucose and serum insulin concentration
207
Which macronutrient should be limited in the diet for patients with GDM?
Carbohydrate
208
What is the suggested distribution of meals and snacks per day for carbohydrate intake in GDM management?
3 meals and 2-3 snacks
209
What are some examples of nutrient-dense foods recommended in the diet for GDM management?
Fruits, vegetables, legumes, whole grains, healthy fats with omega-3 fatty acids
210
According to the systematic review, does dietary intervention in GDM management reduce the risk of macrosomia?
Yes
211
What is the mean difference in infant birth weight associated with dietary interventions in GDM management?
170.6 g
212
What is the conclusion of the Cochrane review regarding the association between vitamin D supplementation and gestational diabetes?
Vitamin D supplementation is associated with a decreased risk of gestational diabetes.
