Pregestational Problems Flashcards
What age is a risk factor for gestational diabetes?
> 30
What are the risk factors of gestational diabetes? (3)
- History of type 2 diabetes / gestational diabetes
- Previous macrosomia
- Previous still birth
During pregnancy, changes in the mother’s metabolism are due to ______
Placental hormones
Describe the pathophysiology of gestational diabetes (4)
- hPL increases blood glucose
- Insulin resistance
- Mother becomes hyperglycemic
- Fetus deprived of glucose
What is the reason for the timing of diabetic screening during pregnancy?
Occurs at time of peak insulin resistance in the case of gestational diabetes (peak = 24 - 28 weeks)
When is a blood glucose screen conducted?
24 - 28 weeks
Describe the process of glucose testing in pregnancy (4)
- 1 hour 50 gram test
- If ≥ 130 - 140 ..
- 3 hour 100 gram test
- 2 abnormal tests - indicates gestational diabetes
What are the possible complications for an insulin dependent diabetic mother? (3)
- Polyhydramnios - fetal polyuria
- Preeclampsia
- DKA
What factor increases the risk of preeclampsia secondary to gestational diabetes?
Vascular involvement - nephropathy / hypertension
What is the expected fasting blood glucose after 1 hour?
< 180
What is the expected fasting blood glucose after 2 hours?
< 155
What is the expected fasting blood glucose after 3 hours?
< 140
Describe the frequency of antepartum visits for a mother with gestational diabetes
Every 2 weeks until 28 weeks and then weekly
For gestational diabetes, it is recommended to have an intake of ______ kcal / kg
30 - 35
What are the benefits of walking after meals associated with gestational diabetes? (2)
- Increases insulin effectiveness
- Prevents excessive weight gain
How often should glucose monitoring take place?
4 times / day
At what times should glucose monitoring take place? (4)
- Preprandial
- 1 hour postprandial
- 2 hours postprandial
- Bedtime
What congenital defects can result from a pregnancy with poor glucose control? (4)
- Heart anomalies
- Neural tube defects
- Restricted growth
- Macrosomia
What test determines diabetic control over the past 4 - 12 weeks?
Glycosylated hemoglobin (HgbA1c)
______ above the normal range for HgbA1c increases risk of congenital abnormalities
1%
______ may be performed in the case of poorly regulated diabetes to assess fetal lung maturity
Amniocentesis
Hyperglycemia during pregnancy delays …
Fetal lung maturity
Timing of delivery is dependent on what maternal factors? (2)
- Vascular diseases
- Diabetes control
Timing of delivery is dependent on what fetal factors? (2)
- Fetal weight
- Fetal distress
