Module 2 - part 2 gestational diabetes

Question 1

what is gestational diabetes mellitus (GDM)

- rate?

Answer 1

mothers who have never had diabetes but have high blood glucose during pregnancy
- 9% of women

Question 2

GDM cause

Answer 2

• hormones produced by placenta help fetal growth, but cause insulin resistance in mother
• mother unable to produce insulin needed for euglycemia (normal bl.gluc)
• resistance until conception
• more gluc. shunted to developing fetus
• 50% less efficient at clearing blood gluc during pregnancy
• pancreas must produce 2x more insulin

Question 3

Risk factors for developing GDM

Answer 3

• age >25
• excess weight (>30 BMI)
• native americans and asian-pacific islanders
• 1st degree relatives with diabetes
• previous history of GDM, still births, or large babies

Question 4

consequences of GDM

Answer 4

• glucose, aminos, ketones pass freely across placenta from mother to fetus
• mother hyperglycemia = fetus high blood sugar
• responds by increasing insulin
• anabolic hormone promotes growth, increases birthweight of baby (macrosomia)

Question 5

long term effects of GDM on offsrping

Answer 5

intergenerational T2D occurs via maternal line (no paternal influence)

• increased risk of metabolic diseases (T2D and obesity)
• risk depends on genetic susceptibility and postnatal environment
• large prevalence of overwieght in mothers with GDM
• insulin resistance prevelance in offspring of mother with diabetes (in general)
• maternal BMI effects offspring weight

Question 6

Maternal vs Paternal diabetes on offsrping risk of development

Answer 6

maternal 3x increase diabetes
paternal no effect

*importance of unterine environment

Question 7

Other effects of GDM on offsrping

Answer 7

birth defects rare
- arise first weeks of development
- GDM arises around 24weeks into pregnancy
macrosomia
respiratory distress syndrome
hypertension (SBP, not DBP, higher effect in males)
low HDL-cholesterol

*wont always develop, but maternal GDM increases risk

Question 8

GDM after pregnancy

- problem when explaining risk?

Answer 8

glucose homeostasis returns to normal

• but are at higher T2D and metabolic disease risk later in life
• 1 in 5 develop T2D within 9 years
• 7x higher risk T2D development with GDM
• only 16% of women “believed” they were at higher risk

Question 9

how to calculate relative risk

Answer 9

(occurrences / total) / (occurrences / total)

- with - without

Question 10

how to reduce GDM risk

Answer 10

exercise

- more exercise, more risk reduction

Question 11

how to test at risk GDM women

- treament

Answer 11

oral glucose tolerance test (OGTT)
- 24-28 weeks into pregnancy (3rd trimester)

treament
- dietician to reduce kcal
- increase activity
if unsuccessful
- insulin therapy
-metformin therapy

Question 12

OGTT

Answer 12

oral glucose tollerance test

• 75g glucose drink
• spike in blood glucose
• drop fast if good, wont drop if bad

Question 13

vitamin effecting GDM

Answer 13

vit D

• acts on pancreatic beta cells to regulate intracellular calcium
• intracellular calcium regulates insulin release from beta cells
• not sure how this works yet