Mehl gestational DM 12-18 (1)

Question 1

when is done screening?

Answer 1

in all women at 24-28 weeks

Question 2

what about first trimester glucose screening?

Answer 2

not done in general

Question 3

when is done first trimester glucose screening?

Answer 3

in female considered high risk (ie obesity, FHx of type II DM, or previous pregnancy with fetal macrosomia)

Question 4

how is performed screening? if after one hour glu >130, what is done?

Answer 4

Screening is done with non-fasting 50-g glucose challenge.
If after 1 hour, glucose is >130 mg/dL, a 100-g oral glucose tolerance test (OGTT) is performed.

Question 5

100-g oral glucose tolerance test (OGTT). gestational is diagnosed when what criteria?

Answer 5

2 or more are seen:
- Fasting glucose (prior to the test in the morning): >95 mg/dL;
- 1 hour after: >180 mg/dL;
- 2 hours after: >155 mg/dL;
- 3 hours after; >140 mg/dL.

Question 6

100-g oral glucose tolerance test (OGTT). gestational is diagnosed when what criteria?
2 or more are seen:
- Fasting glucose (prior to the test in the morning): …
- 1 hour after: >180 mg/dL;
- 2 hours after: >155 mg/dL;
- 3 hours after; >140 mg/dL.

Answer 6

> 95 mg/dL;

Question 7

100-g oral glucose tolerance test (OGTT). gestational is diagnosed when what criteria?
2 or more are seen:
- Fasting glucose (prior to the test in the morning): >95 mg/dL;
- 1 hour after: ……..
- 2 hours after: >155 mg/dL;
- 3 hours after; >140 mg/dL.

Answer 7

> 180 mg/dL;

Question 8

100-g oral glucose tolerance test (OGTT). gestational is diagnosed when what criteria?
2 or more are seen:
- Fasting glucose (prior to the test in the morning): >95 mg/dL;
- 1 hour after: >180 mg/dL;
- 2 hours after: …..
- 3 hours after; >140 mg/dL.

Answer 8

> 155 mg/dL;

Question 9

100-g oral glucose tolerance test (OGTT). gestational is diagnosed when what criteria?
2 or more are seen:
- Fasting glucose (prior to the test in the morning): >95 mg/dL;
- 1 hour after: >180 mg/dL;
- 2 hours after: >155 mg/dL;
- 3 hours after; ….

Answer 9

> 140 mg/dL.

Question 10

• If a woman has GDM, she must be followed up postpartum.
  6-12 weeks postpartum - what is done?

Answer 10

Do a 75-g OGTT

Question 11

• If a woman has GDM, she must be followed up postpartum:
• Do routine diabetes screening every ….? what 2 tests?

Answer 11

1 year thereafter (asked on NBME). This refers to standard fasting glucose and HbA1c.

Question 12

gold standard for glycemic control in pregnancy?

Answer 12

insulin

Question 13

Oral hypoglycemics (e.g., metformin, glyburide) can be used during pregnancy, but once again, insulin is preferred. During parturition, if a patient is on one of these agents, she is switched over to insulin because this allows for tighter glucose monitoring and control.

Answer 13

.

Question 14

Main intrapartum FETAL complication of GDM?

Answer 14

GDM is shoulder dystocia, where the anterior fetal shoulder gets caught behind the maternal pubic symphysis. This is because GDM often causes macrosomia (big baby; >4,000g).

Question 15

Main MATERNAL complication is vaginal tear/laceration due to the shoulder dystocia. In the setting of vaginal delivery, McRobert’s maneuver is implemented (i.e., flexion of maternal hips + application of suprapubic pressure) + an episiotomy is often performed, followed by suturing postpartum. This prevents uncontrolled laceration into the peroneal body / external anal sphincter, leading to fecal incontinence.

Answer 15

.

Question 16

GDM can also cause ….. due to……

Answer 16

GDM can also cause polyhydramnios due to fetal polyuria (­glucose in the fetus pulls water with it through the fetal kidneys, similar to children and adults with DM).

Question 17

cross of placenta. insulin? glucose?

Answer 17

Maternal insulin does not cross the placenta. Only glucose does.

Question 18

The fetus will produce its own insulin in
response to hyperglycemia, leading to fetal hyperinsulinemia. Following parturition, when the transplacental glucose is removed, the fetal insulin levels remain high. This can cause hypoglycemia in the fetus, presenting with rigors or even seizure.

Answer 18

.

Question 19

what is seen in neonates of diabetic moms. one or more of pentad?

Answer 19

One or more of the pentad of hypoglycemia, hyperbilirubinemia, polycythemia, hypocalcemia, and
hypomagnesemia

Question 20

There is a difficult Peds Q on a 2CK form where they ask why a neonate whose mom had GDM has seizure, and the answer is “decreased gluconeogenesis” (because insulin is high). Makes sense, but difficult Q to draw the conclusion.

Answer 20

.

Question 21

If the Q gives you neonate with QT changes on ECG, choose what answer? 2

Answer 21

choose hypocalcemia over hypomagnesemia (even though the latter can cause the former).