OB: LATE PREGNANCY GDM Flashcards
How is blood sugar and regulation impacted in pregnancy (in an individual without DM)?
The hormones released by the placenta are functional insulin antagonists—the placenta keeps the maternal blood glucose higher than normal to ensure that the fetus has enough glucose. Therefore, pregnancy induces relative insulin resistance.
A healthy woman’s pancreas will respond in kind—high blood glucose results in more insulin release. The placenta steals the glucose from the maternal serum while maternal insulin is increased. Thus, insulin resistance results in postprandial hyperglycemia and, therefore, hyperinsulinemia,whereas excess insulin secretion coupled with increased glucose uptake by the placenta results in preprandial hypoglycemia.
When can we diagnose GDM and what is first line management?
Gestational diabetes develops during pregnancy (like preeclampsia, after 20 weeks’ gestation). If a woman has diabetes before pregnancy, the goal should be strict glucose control prior to conception to optimize fertility and minimize risk to the fetus. If a woman develops gestational diabetes, the initial treatment is the same as for preconception diabetes—control the blood glucose with diet and lifestyle. Thirty minutes of moderate exercise (walking counts) 5 days per week while reducing carbohydrate intake is often successful in controlling blood glucose.
When do we do GDM screening?
Gestational diabetes screening is done for all pregnancies in the third trimester (24–36 weeks’ gestation). A1c cannot be used to screen for gestational diabetes because insulin resistance continually worsens throughout gestation, and the A1c level represents the past 90 days’ glucose levels.
How do we screen for GDM?
In obstetrics, gestational diabetes is screened for with a 1-hour glucose tolerance test followed by a 3-hour glucose tolerance test if the 1-hour test is positive.
When is GDM screeninginficated before thrid trimester?
Screening at the first prenatal visit should be offered for overweight and obese patients with risk factors for diabetes using the same two-step approach, a 1-hour OGTT followed by a 3-hour OGTT if the first is positive.
Why are sulfonylureas (like glipizide) contrindicated in pregnancy?
Sulfonylureas cross the placenta and induce the fetal pancreas to secrete excess insulin, leading to macrosomia. Sulfonylureas (glyburide) should NOT be used in pregnancy, as they cause hyperinsulinemia in the fetus
What is positive for glucose screening tests?
Fasting max is 105. One hour should be less than 190, 3 hour should be less than 145. Anything more than this is positive.
When do we rescreen moms with GDM postpartum?
All women with gestational diabetes should be rescreened for diabetes mellitus (chronic diabetes) between 4 and 12 weeks post partum.Screen for chronic diabetes with the 75-g OGTT, the 2-hour glucose tolerance test.
we dont use a1c for this.
Why is hyperglycemia in pregnancy bad?
Hyperglycemia is teratogenic. Preconception hyperglycemia carries a risk for cardiac abnormalities, which result from hyperglycemia in the first 5 weeks of gestation and are not induced by the diabetogenic state caused by the placenta.
How does GDM lead to shoulder dystoica?
Maternal insulin does NOT cross the placenta, but maternal glucose does. Therefore, the fetal endocrine system responds to excess blood glucose. The fetal pancreas secretes excess fetal insulin in response to the elevated blood glucose. Fetal insulin, like adult insulin, acts as a growth factor, leading to macrosomia and subsequent complications, such as cesarean delivery or shoulder dystocia.
What is the difference between GDM A1 vs A2?
A2 requires medical managment whereas A1 managed with diet and lifestyle
When do we deliver in GDM?
