Pregnancy and GDM Flashcards
For those with pre-existing diabetes, what is the goal A1C during pregnancy?
<7%
Why is planned pregnancy important?
Fetal organ formation takes place in first 8 weeks and uncontrolled glucose may result in spontaneous abortion or congenital abnormalities (neural tube, heart, kidneys)
What happens at 18 weeks gestation when the placenta is fully grown and functioning?
The fetus can now develop metabolic complications secondary to the maternal hyperglycemia
What are the metabolic complications from maternal hyperglycemia?
Macrosomia, increased risk childhood obesity, glucose intolerance, stillbirth, respiratory distress syndrome, and hyperbilirubinemia
What is the most common complication of the second and third trimester maternal hyperglycemia?
Neonatal hypoglycemia
How is neonatal hypoglycemia defined?
35 mg/dl or less in full term OR
25 mg/dl or less in preterm infants
What is macrosomia?
Abnormally high birth weight
What are the maternal complications of uncontrolled glucose?
Hypertension
Preterm labor and delivery
C-section
Pyelonephritis
What is pregnancy-induced hypertension also known as?
Preeclampsia
How is chronic hypertension treated in pregnant women with diabetes?
Calcium channel blocker and labetalol are substituted. ACE and ARB are CONTRAINDICATED.
What is the target blood pressure in pregnant diabetic?
110/65 to 129/79 mmHg
What is the most significant risk factor for progression of retinopathy in pregnancy?
Hypertension
Under what circumstances might C-section be the best option?
- Proliferative retinopathy (to prevent the Valsalva maneuver, which could lead to retinal hemorrhage)
- High birth weight neonate
What is the chance of having a Type 1 in a mother with Type 1?
2%
What is the chance of having a Type 1 in a father with Type 1?
6%
What is gestational diabetes?
Carbohydrate intolerance at onset or first recognition in pregnancy
What is the screening for GDM?
Screen all women at first prenatal visit.
Test between 24-28 weeks for those with average risk.
Use 75 gram oral glucose tolerance test (OGTT)
When is GDM diagnosed?
One of the following:
Fasting blood glucose >92 mg/dl
1 hour post-OGTT is >180 mg/dl
2 hour post-OGTT is >158 mg/dl
Women at high risk for diabetes should be tested ASAP and those risk factors include:
History of GDM
Family history of diabetes
Obesity
Glycosuria
Why is pregnancy considered a diabetogenic state?
Hormones in pregnancy (progesterone, human placental hormone, and prolactin) lead to insulin resistant state
What happens to blood sugar levels in the third trimester?
They double or triple due to increased needs of the placenta
True or false: Ketones are harmful to the fetus.
True, so avoid this by refraining from unsupervised weight loss (and check for ketones late in pregnancy)
What happens immediately postpartum?
Insulin sensitivity increases due to hormonal changes, though they typically promptly return to normal insulin requirements.
Blood glucose level targets for GDM:
Premeal/bedtime/overnight: 60-99 mg/dl
Peak postprandial: 100-129 mg/dl
What medications are used to treat GDM?
Insulin mostly, though glyburide and metformin have also been studied.
What is a woman’s risk of diabetes within 10 years after having GDM?
40-60%
What is recommended postpartum after GDM?
Self-monitor blood glucose until normoglycemic and 6 week OGTT
What follow-up tests should be done after having GDM?
Fasting plasma glucose test annually and 75 gram OGTT every 3 years.
True or false: Breastfeeding is contraindicated if the mother has diabetes
FALSE
What can ketones cause in fetus?
Exposure is associated with fetal demise and lower IQ scores.
Indications for ketone testing in GDM:
Blood glucose >200 mg/dl
Significant vomiting with morning sickness/illness
**Infection is the most common cause of ketosis.
When ketones are present with normal or low blood glucose, what is suspected?
Inadequate food intake
When ketones are present with high blood glucose, what is suspected?
Ketosis will be imminent
If vomiting occurs after taking a short-acting premeal insulin, what should the patient do?
Take enough glucagon to raise blood glucose 30-40 mg/dl to prevent hypoglycemia. This works for 1-2 hours, to allow for food to be taken. Monitor closely and more glucagon if the patient can’t eat until time for peak action of the insulin is reached.
