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21 Cards in this Set

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type 1 pregestational
absolute insulin deficiency
type 2 pregestational
insulin resistance or deficiency
gestational diabetes defined
glucose intolerance due to pregnancy
risks during wk 1-20
increased risk for HYPOglycemia.. insulin production increases (n/v)
risks during wk 20-40
increased risk for HYPERglycemia.. BS increases as well as cortisol (decreases insulin effects)
------ hormones cause insulin resistance
placental
risk factors for gestational diabetes
prior Hx
obesity
family Hx of DM2
multiple pregnancies
age >25
Hx of polycystic ovaries
AA, latina, native american, pacific islander
previous fetal death
previous infant >9lb
1st screening for gestational diabetes is
50g glucose challenge
a result of _____________ in an initial glucose challenge requires no further testing
BS <140
This test is required if initial glucose challenge is abnormal
3hr GTT
Dx of gestational diabetes is confirmed if these tests are positive
1 hr glucose challenge
3 hr GTT
The medical Tx of choice for gestational diabetes is
insulin injection. we dont know effects of oral insulin on fetus
best mgmt Tx for gestational diabetes
diet control:
45% complex carbs
20% protein
35% fat
normal weight gain during pregnancy is
25-35 pounds
schedule of visits for a gestational diabetic mom
q 2 wk in 1st and 2nd trimester
q wk in 3rd
AFP test at 16 wks
sonography 18 wks
fetal echo 20 wks
28-34 wks sonography again
teach mom to monitor BS....
on rising
1-2 hr after breakfast
before and after lunch
before dinner
bedtime
fetal complications r/t gestational diabetes
LGA/macrosomia: >8lb 13oz
SGA: <10% for GA
underdeveloped fetus
labor dystocia
shoulder dystocia
canal damage
fetal hyperglycemia
fetal hypocalcemia
>WBC
>bilirubin
childhood obesity
preterm
cord prolapse
RDS
asphyxia
cardiac defects
neural tube defects
maternal complications r/t gestational diabetes
anxiety, guilt, fear
hypoglycemia
psychosocial interventions for mom
develop positive coping mechanisms
focus on 'normal' part of pregnancy
allow mom to make decisions about diet
acknowledge concerns
most common post partal neonatal complications
RDS
hyperbilirubinemia
hyper/hypoglycemia - most likely hypo
post partal maternal care
monitor BS
> calories if breastfeeding
s/s of hypo/hyperglycemia