Gestational Diabetes Mellitus (GDM) Dynamed Flashcards
What are the risk factors for gestational diabetes mellitus (GDM) mentioned in the notes?
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.
What was the primary outcome measured in the RADIEL trial mentioned in the notes?
The primary outcome measured in the RADIEL trial was GDM at 24-28 weeks gestation, determined using oral glucose tolerance test.
What were the outcomes compared between the lifestyle intervention group and standard antenatal care group in the randomized trial mentioned in the notes?
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.
What was the evidence mentioned for the use of metformin for prevention of GDM?
The notes mentioned evidence for the use of metformin for prevention of GDM, but the specific details were not provided.
What is the initial diagnostic investigation for gestational diabetes mellitus (GDM) recommended by ACOG?
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.
What is the screening test for GDM recommended by ACOG?
The screening test for GDM recommended by ACOG is a 1-hour oral glucose tolerance test after a 50 g glucose load.
What are the suggested thresholds for the 1-hour glucose screening test for GDM?
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.
What are the diagnostic criteria for GDM based on the 100-g 3-hour oral glucose tolerance test?
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.
Why does ACOG not recommend the diagnosis of GDM based on the 1-step screening and diagnosis test?
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.
What is the 2-step approach to screening and diagnosis of GDM recommended by the Canadian Diabetes Association (CDA)?
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.
What are the diagnostic criteria for GDM based on the 75-g oral glucose tolerance test in the 2-step approach recommended by CDA?
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.
What is the 1-step approach to the diagnosis of GDM recommended by the World Health Organization (WHO)?
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).
What is the sensitivity of HbA1c measurement for detection of diabetes at ADA recommended cutoff?
The sensitivity of HbA1c measurement for detection of diabetes at ADA recommended cutoff of ≥ 6.5% is 19.4%.
What is the specificity of HbA1c measurement for detection of diabetes at ADA recommended cutoff?
The specificity of HbA1c measurement for detection of diabetes at ADA recommended cutoff of ≥ 6.5% is 98%.
What is the positive predictive value of HbA1c measurement for detection of diabetes at ADA recommended cutoff?
The positive predictive value of HbA1c measurement for detection of diabetes at ADA recommended cutoff of ≥ 6.5% is 35%.
What is the negative predictive value of HbA1c measurement for detection of diabetes at ADA recommended cutoff?
The negative predictive value of HbA1c measurement for detection of diabetes at ADA recommended cutoff of ≥ 6.5% is 95.7%.
What is the sensitivity of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4%?
The sensitivity of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4% is 41.2%.
What is the specificity of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4%?
The specificity of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4% is 72.2%.
What is the positive predictive value of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4%?
The positive predictive value of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4% is 63.7%.
What is the negative predictive value of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4%?
The negative predictive value of HbA1c measurement for detection of prediabetes at ADA recommended cutoff of 5.7%-6.4% is 50.9%.
What improvements were associated with a soy diet in patients with gestational diabetes mellitus?
A soy diet was associated with improved maternal fasting plasma glucose, serum insulin, triglycerides, and biomarkers of oxidative stress.
What were the findings of the Cochrane review on probiotics in pregnant patients with gestational diabetes mellitus?
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.
What were the findings of the randomized trial on magnesium supplementation in women with magnesium deficiency and gestational diabetes mellitus?
The randomized trial found that magnesium supplementation was associated with a reduced risk of newborn hyperbilirubinemia and hospitalization.
What is the difference in glycemic control between 4 times-daily regimen and twice-daily regimen for GDM patients?
91.3% of patients achieved adequate glycemic control with the 4 times-daily regimen compared to 74.3% with the twice-daily regimen.
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.
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.
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).
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.
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.
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%.
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.
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.
What is the association between twin pregnancies and gestational diabetes?
Twin pregnancies are associated with an increased risk of developing gestational diabetes.
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).
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.
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).
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).
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).
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).
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.
What is the association between PCOS and hypertensive disorders in pregnancy?
PCOS is associated with an increased risk of hypertensive disorders in pregnancy.
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.
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%.
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).
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).
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.
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.
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%.
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.
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.
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.
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).
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).
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.
What is the definition of macrosomia in the context of birth weight?
Macrosomia refers to birth weight greater than 4 kg (8.82 lbs).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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).
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
