Pregnancy

Question 1

When should preconception counseling start and end?

Answer 1

start @ puberty

continue as long as they are of reproductive age

Question 2

When should woman begin trying for baby

Answer 2

when treatment regimen and A1c is optimized

until then discuss family planning and effective contraception

Question 3

Glu levels should be __________________ before pregnancy

Answer 3

as close to normal as safely possible

Question 4

when does organogenesis start?

Answer 4

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

Question 5

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

Answer 5

<6.5

Question 6

A multidisciplinary clinic for pregnant women w/ DM includes

Answer 6

Endo
Maternal fetal medicine specialist
RD
CDE

Question 7

Women w/ DM are at increased risk for ________during pregnancy

Answer 7

diabetic retinopathy

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

Question 8

prenatal vitamins

Answer 8

400 mg folic acid

150 micrograms potassium iodide

Question 9

ways to reduce risk of adverse outcomes

Answer 9

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

Question 10

DM specific testing includes

Answer 10

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

Question 11

Aspirin recommendations

Answer 11

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

Question 12

When should pregnant women check BG

Answer 12

Fasting and postmeal

Question 13

Why is A1c lower in pregnancy

Answer 13

RBC turnover increases

Question 14

CGM

Answer 14

can reduce hypo and macrosomia

but must be used along with finger pricks

Question 15

mgmt of GDM

Answer 15

lifestyle (most)

insulin

Question 16

Refer to RD for

Answer 16

wt gain goals
insulin/CHO ratio
meal plan

Question 17

Early pregnancy is time of

Answer 17

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

Question 18

BG goals in pregnant T1, T2, GDM

Answer 18

Fasting <95
1 Hour <140
2 Hour <120

Question 19

BG testing in pregnant women

Answer 19

prandial- if on insulin pump, basal bolus

postprandial- associated w/ better glycemic control

Question 20

A1c goal in pregnancy

Answer 20

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

Question 21

why is hypo bad

Answer 21

reduces risk of low birth weight

Question 22

What is more appropriate than A1c?

Answer 22

SMBG

Question 23

when should metformin be d/c

Answer 23

by end of first trimester

Question 24

GDM characteristics

Answer 24

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

Question 25

lifestyle MGMT

Answer 25

MNT PA WM Glu monitoring

Question 26

DRI for pregnant women

Answer 26

71 g PRO 175 g CHO 28 g fiber

Question 27

metformin should not be used bc

Answer 27

umbillical cord blood | HTN, preeclampsia, intrauterine growth restriction

Question 28

sulfonylureas

Answer 28

increased neonatal hypo

Question 29

wt gain recs in pregnancy

Answer 29

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

Question 30

ketosis in T1DM

Answer 30

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

Question 31

glycemic control

Answer 31

easier to achieve in T2DM v T1DM | may need much higher dose of insulin

Question 32

BP Goals in DM/HTN

Answer 32

135/85 | NOT lower than 120/80 bc it impairs fetal growth

Question 33

AntiHTN meds

Answer 33

``` methyldopa nifedipine labetolol prazosin diltiazem clonidine ```

Question 34

what are insulin requirements after delivery?

Answer 34

1/2 pre-pregnancy requirements | insulin sensitivity returns to prepregnancy values over 1-2 weeks

Question 35

when to screen women w/ GDM

Answer 35

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

Question 36

hypo concerns after delivery

Answer 36

during breastfeeding overnight erratic sleep insulin dosing may need adjustments

Question 37

insulin needs during pregnancy

Answer 37

insulin resistance ~16 weeks | TDD increase linearly 5% per week through week 36 --> doubling of daily dose vs pre-pregnancy requirement

Question 38

CGM in pregnancy values

Answer 38

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

Question 39

why is untreated GDM bad for offspring

Answer 39

reduced insulin sensitivity & Bcell compensation | IGT in childhood likely

Question 40

Women w/ GDM have X fold increase in developing T2DM

Answer 40

10x

Question 41

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

Answer 41

35-40%

Question 42

one step method for GDM test

Answer 42

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

Question 43

two step method GDM

Answer 43

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 ```