Medical Complications of Pregnancy II -Castro

Question 1

What are some of the fetal risks of DM in pregnancy?

Answer 1

-maternal hyperglycemia leads to fetal hyperglycemia and hyperinsulinemia –> increased risk for macrosomia, polyhydramnios, fetal demise, shoulder dystocia (can cause Erb’s palsy form brachial plexus damage)

also affects type II pneumocytes and surfactant synthesis

Question 2

What are the neonatal risks for DM in pregnancy?

Answer 2

neonatal hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, cardiomyopathy

Question 3

What is a Class A diabetes in pregnancy classification?

Answer 3

gestational diabetes

all others are pre-gestational

Question 4

How does GDM (gestational DM) normally present? What hormone plays a role in this?

Answer 4

• develops in late 2nd or early 3rd trimester (after organogenesis) due in part to the rise in human placental lactogen (HPL)
• HPL=placental hormone with GH like effects that worsens insulin resistance

Question 5

What are the risk factors for diabetes in pregnancy?

Answer 5

• Age > 25
• Weight : BMI >30
• Family history of 1ST degree relatives with diabetes
• Previous history of Diabetes
• H/O of macrosomia, unexplained stillbirths, malformations
• Heavy glycosuria
• Multiple gestation

Question 6

What is the 2 step screening approach for GDM?

Answer 6

• screen in 1st tri if have risks: 50 gm glucose challenge
• if abnormal follow with a 3 hour GTT (glucose tolerance test) –> if abnormal too=GDM
• If NOT done in 1st tri, test at 24-28 weeks with same tests

Question 7

What are the target glucose levels in GDM?

Answer 7

• fasting blood glucose 70-90
• 1 hour postprandial blood sugar (PPBS) 100-130

if these are > than expected on a diabetic diet, add insulin or glybride

Question 8

What is the first line management of GDM? What is the second line?

Answer 8

1st: diabetic diet and exercise
2nd: insulin=good standard

Question 9

What additional risks do pregestational diabetics have?

Answer 9

all of the risks for GDM and IN ADDITION THEY ARE AT RISK FOR for IUGR, fetal demise at an earlier gestational age, prematurity, severe preterm preeclampsia, congenital anomalies (especially cardiac and neural tube defects)

-assess for maternal end-organ damage and fetal assessment

Question 10

Why is preconception counseling important in pre-gestational diabetics?

Answer 10

An elevated Hgb A-1C preconception or in the first trimester increases the risk of fetal anomalies

important to control DM BEFORE pregnancy

Question 11

Do insulin requirements increase or decrease after delivery? Why?

Answer 11

decrease “insulin holiday” due to delivery of the placenta and decline in HPL and other hormones

Question 12

What are GDMs at risk for post partum?

Answer 12

diabetes, especially if don’t change diet/weight

perform a 75 gm GTT 6-8 weeks post partum to determine

Question 13

What percentage of pregnancies are unplanned?

Answer 13

50%