Pregnancy Flashcards
When should preconception counseling start and end?
start @ puberty
continue as long as they are of reproductive age
When should woman begin trying for baby
when treatment regimen and A1c is optimized
until then discuss family planning and effective contraception
Glu levels should be __________________ before pregnancy
as close to normal as safely possible
when does organogenesis start?
5-8 weeks gestation, before woman may realize she’s pregnant
What A1c is associated w/ lowest risk of congenital abnormalities?
<6.5
A multidisciplinary clinic for pregnant women w/ DM includes
Endo
Maternal fetal medicine specialist
RD
CDE
Women w/ DM are at increased risk for ________during pregnancy
diabetic retinopathy
get dilated eye exam prior to pregnancy or in 1st trimester, monitor each trimester, and then for 1 year post partum
prenatal vitamins
400 mg folic acid
150 micrograms potassium iodide
ways to reduce risk of adverse outcomes
MNT
lifestyle management
glycemic goal setting
especially in 1st or 2nd trimester to reduce risk of GDM
DM specific testing includes
A1c creatinine UACR review of meds list for potentially harmful meds (ACE, ARBS, statins) refer for eye exam
Aspirin recommendations
100-150 mg low dose aspirin by 16 weeks/1st trimester to reduce risk of preeclampsia
reduces mortality, morbidity, lowers health care costs
When should pregnant women check BG
Fasting and postmeal
Why is A1c lower in pregnancy
RBC turnover increases
CGM
can reduce hypo and macrosomia
but must be used along with finger pricks
mgmt of GDM
lifestyle (most)
insulin
Refer to RD for
wt gain goals
insulin/CHO ratio
meal plan
Early pregnancy is time of
increased insulin sensitivity
lower glucose levels
may increase risk of hypo
lower insulin requirements in t1DM
BG goals in pregnant T1, T2, GDM
Fasting <95
1 Hour <140
2 Hour <120
BG testing in pregnant women
prandial- if on insulin pump, basal bolus
postprandial- associated w/ better glycemic control
A1c goal in pregnancy
<6-6.5
<6 in 2nd to 3rd trimesters
lowest risk for LGS, preterm delivery, preeclampsia
why is hypo bad
reduces risk of low birth weight
What is more appropriate than A1c?
SMBG
when should metformin be d/c
by end of first trimester
GDM characteristics
macrosomia
birth complications shoulder dystocia
maternal t2DM after pregnancy
highest risk of birth defect with progressive hyper
lifestyle MGMT
MNT
PA
WM
Glu monitoring
DRI for pregnant women
71 g PRO
175 g CHO
28 g fiber
metformin should not be used bc
umbillical cord blood
HTN, preeclampsia, intrauterine growth restriction
sulfonylureas
increased neonatal hypo
wt gain recs in pregnancy
underweight- 28-40 lbs
normal weight- 25-35 lbs
overweight- 15-25 lbs
obese 11-20 lbs
ketosis in T1DM
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
glycemic control
easier to achieve in T2DM v T1DM
may need much higher dose of insulin
BP Goals in DM/HTN
135/85
NOT lower than 120/80 bc it impairs fetal growth
AntiHTN meds
methyldopa nifedipine labetolol prazosin diltiazem clonidine
what are insulin requirements after delivery?
1/2 pre-pregnancy requirements
insulin sensitivity returns to prepregnancy values over 1-2 weeks
when to screen women w/ GDM
4-12 weeks post partum
75 g OGTT
ILI or metformin to prevent DM
LT screening for DM/pre-DM every 3 years
hypo concerns after delivery
during breastfeeding overnight
erratic sleep
insulin dosing may need adjustments
insulin needs during pregnancy
insulin resistance ~16 weeks
TDD increase linearly 5% per week through week 36 –> doubling of daily dose vs pre-pregnancy requirement
CGM in pregnancy values
TIR >70% time 63-140
below 63<4%
below <54 <1%
Time above range >140 <25%
why is untreated GDM bad for offspring
reduced insulin sensitivity & Bcell compensation
IGT in childhood likely
Women w/ GDM have X fold increase in developing T2DM
10x
Lifestyle + Metformin reduced progression to T2Dm over 10 years by what %
35-40%
one step method for GDM test
75g OGTT 24-28 weeks gestation any of below values met or exceeded fasting 92 1 hour 180 2 hour 140
two step method GDM
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
