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CDCES > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

When should preconception counseling start and end?

A

start @ puberty

continue as long as they are of reproductive age

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2
Q

When should woman begin trying for baby

A

when treatment regimen and A1c is optimized

until then discuss family planning and effective contraception

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3
Q

Glu levels should be __________________ before pregnancy

A

as close to normal as safely possible

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4
Q

when does organogenesis start?

A

5-8 weeks gestation, before woman may realize she’s pregnant

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5
Q

What A1c is associated w/ lowest risk of congenital abnormalities?

A

<6.5

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6
Q

A multidisciplinary clinic for pregnant women w/ DM includes

A

Endo
Maternal fetal medicine specialist
RD
CDE

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7
Q

Women w/ DM are at increased risk for ________during pregnancy

A

diabetic retinopathy

get dilated eye exam prior to pregnancy or in 1st trimester, monitor each trimester, and then for 1 year post partum

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8
Q

prenatal vitamins

A

400 mg folic acid

150 micrograms potassium iodide

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9
Q

ways to reduce risk of adverse outcomes

A

MNT
lifestyle management
glycemic goal setting
especially in 1st or 2nd trimester to reduce risk of GDM

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10
Q

DM specific testing includes

A 
A1c
creatinine
UACR
review of meds list for potentially harmful meds (ACE, ARBS, statins)
refer for eye exam
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11
Q

Aspirin recommendations

A

100-150 mg low dose aspirin by 16 weeks/1st trimester to reduce risk of preeclampsia
reduces mortality, morbidity, lowers health care costs

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12
Q

When should pregnant women check BG

A

Fasting and postmeal

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13
Q

Why is A1c lower in pregnancy

A

RBC turnover increases

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14
Q

CGM

A

can reduce hypo and macrosomia

but must be used along with finger pricks

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15
Q

mgmt of GDM

A

lifestyle (most)

insulin

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16
Q

Refer to RD for

A

wt gain goals
insulin/CHO ratio
meal plan

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17
Q

Early pregnancy is time of

A

increased insulin sensitivity
lower glucose levels
may increase risk of hypo
lower insulin requirements in t1DM

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18
Q

BG goals in pregnant T1, T2, GDM

A

Fasting <95
1 Hour <140
2 Hour <120

19
Q

BG testing in pregnant women

A

prandial- if on insulin pump, basal bolus

postprandial- associated w/ better glycemic control

20
Q

A1c goal in pregnancy

A

<6-6.5
<6 in 2nd to 3rd trimesters
lowest risk for LGS, preterm delivery, preeclampsia

21
Q

why is hypo bad

A

reduces risk of low birth weight

22
Q

What is more appropriate than A1c?

A

SMBG

23
Q

when should metformin be d/c

A

by end of first trimester

24
Q

GDM characteristics

A

macrosomia
birth complications shoulder dystocia
maternal t2DM after pregnancy
highest risk of birth defect with progressive hyper

25
Q

lifestyle MGMT

A

MNT
PA
WM
Glu monitoring

26
Q

DRI for pregnant women

A

71 g PRO
175 g CHO
28 g fiber

27
Q

metformin should not be used bc

A

umbillical cord blood

HTN, preeclampsia, intrauterine growth restriction

28
Q

sulfonylureas

A

increased neonatal hypo

29
Q

wt gain recs in pregnancy

A

underweight- 28-40 lbs
normal weight- 25-35 lbs
overweight- 15-25 lbs
obese 11-20 lbs

30
Q

ketosis in T1DM

A

should give ketone testing strips
receive ed on ketone prevention/detection
high risk of still birth
if on insulin drip give 10% dextrose if unable to eat to meet higher CHO demands of placenta/fetus

31
Q

glycemic control

A

easier to achieve in T2DM v T1DM

may need much higher dose of insulin

32
Q

BP Goals in DM/HTN

A

135/85

NOT lower than 120/80 bc it impairs fetal growth

33
Q

AntiHTN meds

A 
methyldopa
nifedipine
labetolol
prazosin
diltiazem
clonidine
34
Q

what are insulin requirements after delivery?

A

1/2 pre-pregnancy requirements

insulin sensitivity returns to prepregnancy values over 1-2 weeks

35
Q

when to screen women w/ GDM

A

4-12 weeks post partum
75 g OGTT
ILI or metformin to prevent DM
LT screening for DM/pre-DM every 3 years

36
Q

hypo concerns after delivery

A

during breastfeeding overnight
erratic sleep
insulin dosing may need adjustments

37
Q

insulin needs during pregnancy

A

insulin resistance ~16 weeks

TDD increase linearly 5% per week through week 36 –> doubling of daily dose vs pre-pregnancy requirement

38
Q

CGM in pregnancy values

A

TIR >70% time 63-140
below 63<4%
below <54 <1%
Time above range >140 <25%

39
Q

why is untreated GDM bad for offspring

A

reduced insulin sensitivity & Bcell compensation

IGT in childhood likely

40
Q

Women w/ GDM have X fold increase in developing T2DM

A

10x

41
Q

Lifestyle + Metformin reduced progression to T2Dm over 10 years by what %

A

35-40%

42
Q

one step method for GDM test

A 
75g OGTT 24-28 weeks gestation
any of below values met or exceeded
fasting 92
1 hour 180
2 hour 140
43
Q

two step method GDM

A

50g OGTT non-fasting
1 hour >130, 135, 140–> another day

100g OGTT
2/4 are met
fasting 95
1 h 180
2 h 155
3h 140

CDCES (13 decks)

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