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36 Cards in this Set

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IDMs have ______ the risk of serious birth injury, ______ times risk of C/S, and ______ risk of admission to the NICU
double
triple
quadruple
The two systems that are primarily affected by structural anomalies secondary to GDM include
CNS
Cardiovascular
The primary critical factor in the genesis of diabetes associated birth defects during embryogenesis is
glycemic control during the first 3 to 6 weeks of pregnancy
How is maternal glycemic control monitored?
maternal glycohemoglobin or HbA1C
Define macrosomia
BW greater than the 90th percentile for GA or BW greater than 4Kg
Complications associated with macrosomia
C/S
birth injuries
asphyxia
Birth injuries associated with macrosomia
Shoulder dystocia
Brachial plexus palsy
Fractured clavicle
Glycemic control during the ____ and _____ trimesters decreases the incidence of macrosomia
2nd and 3rd
Macrosomia becomes apparent after ____ weeks
24
Most accurate measure of growth in a potentially macrosomic fetus
abdominal circumference
___________ blood glucose levels during the 2nd and 3rd trimester are strongly predictive of BW and macrosomia
Postprandial
General complications associated with IDMs
macrosomia
hypoglycemia
polycythemia/hyperviscosity
hyperbilirubinemia
hypocalcemia
RDS
birth injury
Define gestational diabetes
glucose intolerance and hyperglycemia during pregnancy
When should routine screening for GDM be done
26-28 weeks
Indications for first trimester glucose screening
age > 25 years
previous infant > 4kg
unexplained fetal demise
previous pregnancy with GDM
family hx of DM
obesity
The definitive diagnosis of GDM is done by
GTT
Definition of polycythemia
Central hgb > 20g/dl or hct > 65%
Polycythemia is usually the result of
increased fetal erythropoetin production
Untreated polycythemia and hyperviscosity can lead to
vascular sludging
ischemia
infarction of vital tissues
Hypoglycemia is the result of
hyperinsulinism
Untreated postnatal hypoglycemia can lead to
seizures
coma
brain damage
The two primary contributing factors for hyperbilirubinemia in IDMs
prematurity
polycythemia
Why are IDMs at increased risk for developing RDS
prematurity
surfactant deficiency
What obstetric complications are associated with GDM
preeclampsia
polyhydramnios
Neonatal hypoglycemia most commonly occurs ___ to ___ hours after birth
1 to 5
Name two metabolic derangements that are common with IDMS. What is the cause.
hypocalcemia
hypomagnesemia
Functional hypoparathyroidism secondary to maternal mg loss
Which cardiac defect is most commonly seen in IDMs
Transposition
What diagnostic studies should be ordered for IDMs and why
glucose: evaluate for hypoglycemia
hematocrit: polycythemia
T and C bili: hyperbili
BMP: Ca and Mg
xray: RDS, TTN
ECHO: cardiac eval
What complication can occur if polycythemia isn't corrected
renal vein thrombosis
IDMs are at future risk for developing
juvenile insulin dependent diabetes
Risk factors for developing GDM
advanced maternal age, multifetal gestation, increased body mass index, and a strong family h/o diabetes
When is GDM typically diagnosed
during the 3rd trimester
What causes delayed lung maturity in IDMs
hyperinsulinemia blocks cortisol induction of lung maturity
Hypoglycemia in IDMs is most commonly seen in
macrosomic infants 1-2 hours after birth
Treatment modalities for hypoglycemia
early feedings
200mg of glucose/Kg (2ml/kg)
Glucose infusion 6-8mg/kg/min
Why is glucagon contraindicated in SGA infants
Poor glycogen stores