gestational DM and DKA Flashcards
Gestational D.M
**Hyperglycemia that is diagnosed for the first
time after 20 weeks of pregnancy
Pathophysiology of Gestational D.M
Pathophysiology involves the diabetogenic effect
of human placental lactogen (hPL)
wil patient develop type DM in future ?
50-70% of GDM patient will develop type 2 DM
within 5-10 years
metabolic effect of human placental lactogen (HPL)
high HPL=high insulin =high glucose in mothers blood=high glucose in fetal blood = baby with extra weight
neonatal complications from diabetic mother
*polycythemia
*organomegaly
*macrosomia
*shoulder dystocia
*birth injuries
*hypoglycemia
*hyperbilirubinemia
*hypocalcemia
*hypomagnesaemia
fetal complications of diabetic mother in first trimester
**congenital anomalies :
congenital (heart diseases, NTD , small left colon syndrome)
** spontaneous abortion
fetal complications of diabetic mother in 2nd and 3rd trimester
fetal hyperglycemia
fetal hyperinsulinemia
cardiac congenital anomalies of diabetic mother
*atrial septal defect
*ventricular septal defect
*transposition of great vessels
*coarctation of aorta
*tetralogy of fallot
*truncus arteriosus
*dextrocardia
*cardiomegaly
CNS congenital anomalies of diabetic mother
*NTD
*anencephaly
*holoprosencephaly
renal congenital anomalies of diabetic mother
*hydronephrosis
*renal agenesis
*ureteral duplication
GI congenital anomalies of diabetic mother
*duodenal atresia
*anorectal atresia
*omphalocele
spinal congenital anomalies of diabetic mother
*caudal regression syndrome
*sacral agenesis
Risk factors:
Age >25 yo
obesity BMI > 30
family hx of diabetes
h\o GDM
ethnicity (african american,native american,asian american )
how to control and manage GDM
**first:Strict diabetic diet and regular daily exercise
* If uncontrolled , or her FBS> 126 at diagnosis , start on insulin +- metformin
Metformin benefits in GDM
- is safe in pregnancy
*improves insulin sensitivity
*not associated with hypoglycemia to the mother
*decrease risk of neonatal hypoglycemia ,LGA babies, PIH, and weight gain
target after GDM management
✓FBS < 95
✓1 hr PP < 141
✓2 hr PP < 115
Postpartum follow up
1) Fasting glucose at 24
72 hr,2-hr 75 g GTT 6
12 weeks
2)Those with normal
glucose tolerance
should be reassessed
every three years
3) Those with impaired
glucose tolerance or
impaired fasting
glucose should be
reevaluated
Delivery to GDM mother
*GDM with normally grown fetus=advice to give birth no later than 40+6 week
*if there is maternal or fetal complications,offer birth before
*if macrosomia baby ,discuss with the mother risks and benefits of vaginal birth ,IOL,CS
Antenatal care for to diabetic patient
**Euglycemic control ( HbA1c < 6.5% )
before pregnancy:decrease risk of miscarriage
* fetal malformation
* still birth and neonatal death.
**Advice for weight loss
**Start on high dose folic acid (5mg )to
decrease risk of neural tube defects
**Start on aspirin to decrease risk of
pre-eclampsia
**Measure HbA1c in each trimester ,
keep on blood sugar profile daily
**Renal and Retinal assessment at
booking and at 28 weeks
macrosomia risk factors
**Maternal factors - diabetes ,obesity,
postdate, multiparity, advanced age, previous
LGA infant
** Fetal factors - Genetic or congenital disorders
(Beckwith-Wiedemann syndrome); male
gender
Fetal monitoring
Screen for fetal
malformations ( detailed
scan) at 20 weeks
* Do fetal echo at 24 weeks
* Fetal growth monthly
* Delivery between 37-39
weeks
Respiratory distress
syndrome
in infants born
to diabetic mothers
is
secondary to diabetes
slowing the production of
surfactant in fetal lungs.
DKA
Severe hyperglycemia due to insulin
deficiency and increase in counter
regulatory hormones ( cortisol,
glucagon, growth hormones )
Lipolysis provides excess free fatty
acids»_space; to the liver.»_space; ketogenesis»_space;
ketoacidosis
DKA is more common with type I
DM, but it can be seen with Type II
DM and GDM
Precipitating
Factors
*Vomiting and hyperemesis
gravidarum
*Starvation
*Infection
*Non compliance on insulin
*Drugs: steroids
