Lecture 13: Gestational Diabetes

Question 1

What are 9 risk factors for Gestational Diabetes Mellitus?

Answer 1

• Maternal Obesity (pre-pregnancy weight 110% + of IBW or BMI >30)
• Maternal age (over 25)
• Previous delivery of baby larger than 9 lbs
• Hx of unexplained perinatal loss or malformation
• Family Hx of diabetes - especially first degree relatives
• Glycosuria at first pre-natal visit
• PCOS
• HTN
• Glucocorticoid use at time of pregnancy (i.e., for asthma or autoimmune disease)

Question 2

What encompasses metabolic syndrome and how is it linked to gestational diabetes?

Answer 2

• A cluster of conditions, 3 or more increase risk for metabolic disease and T2DM
• Insulin resistance
• Elevated fasting glucose
• HTN
• Elevated TAG’s
• Reduced HDL cholesterol
• Abdominal obesity

Question 3

Higher prevelance of T2DM are seen in which 5 populations?

Answer 3

• Pacific Islander
• African American
• Hispanic
• South or East Asian
• Native American

Question 4

What is the range for Impaired Fasting Glucose (IFG), also known as “pre-diabetes” or “intermediate hyperglycemia?”

Answer 4

IGF = 100-125

Question 5

What is the range for Impaired Glucose Tolerance (IGT), also known as “pre-diabetes” or “intermediate hyperglycemia?”

Answer 5

• After glucose challenge
• IGT = 140-199

Question 6

When do we screen for GDM and what type of approach is most common in US?

Answer 6

• At 24-28 weeks gestation
• Two step approach is most common
• Screen w/ 50 gm oral glucose challenge w/ single plasma glucose drawn at one hour; less than 130 is normal
• If greater than 130, then proceed w/ 100g oral glucose challenge in a fasting state (no caloric intake for at least 8 hrs prior to test)

Question 7

When doing the 100 gm OGTT challenge what is a positive test and what are the values at fast, 1 hour, 2 hours, and 3 hours?

Answer 7

• 2 elevated values is a positive test for GDM

Fasting = 95 or higher

1 hour = 180 or higher

2 hour = 155 or higher

3 hour = 140 or higher

Question 8

What happens to the extra glucose in the blood of a mother with gestational diabetes?

Answer 8

• Mother’s blood brings extra glucose to fetus
• Fetus makes more insulin to handle the extra glucose
• Extra glucose gets stored as fat and fetus becomes larger than normal

Question 9

What are some of the maternal complications as a result of gestational diabetes?

Answer 9

• Stillbirth
• Preeclampsia
• Babies that are large for gestational age (LGA), sometimes called “macrosomic”
• Hydramnios: excess amniotic fluid in uterus

Question 10

What is Preeclampsia?

Answer 10

• New onset of HTN (>140/90) and Proteinuria after 20 wks gestation

Question 11

Babies that are large for gestational age (LGA) can cause what problems for the mother?

Answer 11

• Result in perineal lacerations in vaginal birth
• May prompt C-section delivery

Question 12

What are 8 of the complications caused by Polyhydramnios?

Answer 12

• Premature birth
• Premature rupture of membranes
• Excess fetal growth
• Placental abruption
• Umbilical cord prolapse
• C-section delivery
• Stillbirth
• Post partum heavy bleeding due to lack of uterine muscle tone

Question 13

What are 3 increased long term risks for mothers with gestational diabetes?

Answer 13

• T2DM
• T1DM
• Cardiovascular disease

Question 14

What are some of the fetal complications that may be associated with Gestational Diabetes Mellitus?

Answer 14

• Shoulder dystocia
• Brachial Plexus Injury
• Birth trauma: contusions, large hematoma from vacuum extraction, and hypoxia/acidosis
• Increased long term risk for obesity and metabolic syndrome

Question 15

With gestational diabetes you want to monitor the fetus both pre-natally and post-natally, but for what specifically post-natally?

Answer 15

• Hypoglycemia (severe risk)

- Hyperbilirubinemia (especially w/ contusions or hematoma)