Pregnancy and DM

Question 1

What is the pathophys of gestational DM

Answer 1

inc hPL/E/P –> dec glucose uptake by mom/anti-insulin effect

Question 2

what is the incidence of GDM

Answer 2

5-8%

Question 3

RF for GDM

Answer 3

prior GDM, fam history, obesity, non-white

Question 4

what are maternal complications of GDM

Answer 4

polyhydraminos, preE, miscarriage

Question 5

fetal complications of GDM

Answer 5

macrosomia –> shoulder dystocia
hypoCa
hypoglycemia
polycytemia –>hyperviscosity

Question 6

fetal malformations assc with GDM

Answer 6

CV defects, NTDs, caudal regression syndrome, situs inversus, duplex ureter, IUGR

Question 7

How is GDM diagnosed/screened for

Answer 7

screen with glucose challenge test at week 26-28 –> if > 40mg/dl confirm with OGTT

Question 8

How is GDM managed?

Answer 8

tight glc control with diet > insulin > glyburide

induce at 39-40 wks
C/S if macrosomic

Question 9

What is the ideal glc for woman with GDM

Answer 9

70-110

HgbA1c < 6.5%

Question 10

What is the white classification of diabetes?

Answer 10

A1 = GDM, diet controlled
A2 =  GDM, insulin controlled
B = onset >20 y/o, duration 20 yrs
F = neFropathy
R = Retinopathy
RF = Retinopathy + neFropathy
H = ischemic Heart disease
T = prior renal Txp