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49 Cards in this Set

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  • Back
What is the most common endocrine disorder associated with pregnancy?
Diabetes mellitus
What are the classifications of diabetes?
1. Type 1 diabetes
2. Type 2 diabetes
3. Pregestational diabetes mellitus
4. Gestational diabetes mellitus
When does insulin resistance occur during pregnancy?
As early as 14 to 16 weeks of gestation, and continues to rise until it stabilizes during the last few weeks of pregnancy
What is preconception counseling?
An ideal time to plan for the optimal time for pregnancy, establish glycemic control before conception, and diagnose any vascular complications of diabetes
What is Type 1 Diabetes?
1. DM caused by pancreatic islet beta cell destruction
2. More prone to ketoacidosis
3. Have an absolute insulin deficiency
What is Type 2 Diabetes?
1. Most prevalent form of DM
2. Have insulin resistance and usually relative (rather than absolute) insulin deficiency
3. Usually occur in people who are obese or have an increased amount of body fat distributed primarily in the abdominal area
What are the risk factors for Type 2 Diabetes?
1. Abdominal fat
2. Aging
3. Sedentary lifestyle
4. Hypertension
5. Prior gestational diabetes
6. Strong genetic predisposition
What is pregestational diabetes mellitus?
Label given to type 1 or type 2 diabetes that existed before pregnancy
What is gestational diabetes mellitus (GDM)?
1. Any degree of glucose intolerance with the onset or first recognition occurring during pregnancy, whether or not insulin is used for treatment
2. Includes the possibility that the glucose intolerance preceded the pregnancy
What diabetic complication is associated with an increased incidence of miscarriage?
Poor glycemic control around the time of conception
What is the effect of poor glycemic control later in pregnancy?
Increase the rate of fetal macrosomia
What occurs more frequently in diabetic pregnancies?
Preeclampsia and eclampsia
What is associated with preeclampsia and eclampsia?
Increased risks of preterm labor, IUGR, fetal distress, stillbirth, and neonatal death
What is hydramnios?
Amniotic fluid in excess of 2000 mL
What is hydramnios associated with?
Premature rupture of membranes, onset of preterm labor, and postpartum hemorrhage
What is more prevalent during pregnancy?
UTIs
What is the effect of infection in pregnant diabetics?
Increased insulin resistance and may result in ketoacidosis (very serious!)
What is ketoacidosis?
Accumulation of ketones in the blood resulting from hyperglycemia and leading to metabolic acidosis
What increases the risk of diabetic ketoacidosis (DKA)?
1. Maternal metabolism is stressed by illness or infection
2. Use of tocolytic drugs such as terbutaline (Brethine) to treat preterm labor
3. Failure to take insulin properly
What is hyperglycemia?
Excess glucose in the blood
Why is prompt treatment of DKA important?
To avoid maternal coma or death
What is the effect of ketoacidosis during pregnancy?
Can lead to intrauterine fetal death
What is hypoglycemia?
A less than normal amount of glucose in the blood
What is euglycemia?
A normal blood glucose level
What causes hypoglycemia?
Decreased hepatic production of glucose and increased peripheral use of glucose, occurring often during sleep
What can significantly reduce infant morbidity and mortality rates associated with diabetic pregnancy?
Strict control of maternal glucose levels before and during pregnancy
What causes sudden and unexplained stillbirth?
1. Vascular disease
2. Poor glycemic control
3. DKA
4. Preeclampsia
5. Hydramnios
6. Macrosomia
Which systems are commonly affected by anomlies?
1. Cardiovascular system
2. CNS
3. Skeletal system
What blood glucose levels are considered euglycemia?
65 to 105mg/dL
What are the target blood glucose levels during pregnancy?
1. Premeal : between 65 - 105 mg/dL
2. Postmeal (1hr) : <155 mg/dL
3. Postmeal (2hr) : < 130 mg/dL
How is euglycemia achieved?
1. Through a combination of diet, insulin, and exercise

2. With the knowledge, skill, and motivation she needs to achieve and maintain excellent blood glucose control
What are women with diabetes at risk for?
Infections, eye problems, and neurologic changes, so foot care and general skin care are important
What are the dietary goals for pregnant women?
1. Weight gain consistent with a normal pregnancy
2. Prevent ketoacidosis
3. Minimize wide fluctuation of blood glucose levels
What is the average calorie intake for pregnant women?
2200 calories (first trimester) to 2500 calories (second and third trimesters)
What is recommended to help prevent hypoglycemia and starvation ketosis during the night for pregnant diabetics?
A large bedtime snack of at least 25 g of carbohydrate with some protein
What is the recommendation for intake of carbohydrates?
1. Limit simple carbohydrates
2. Increase complex carbohydrates with high fiber content
What is the normal weight gain during pregnancy?
Less than 2 kg during the first trimester, then 1 kg/week afterwards, but approximately only 12 kg during the entire pregnancy
Who should avoid strenuous exercise?
Women with vasculopathy because they depend completely on exogenous insulin and are at greater risk for wide fluctuations in blood glucose levels and ketoacidosis
What is a satisfactory amount of exercise for most pregnant women?
15 to 30 minutes of walking 4 to 6 times a week
What is the insulin dosage during pregnancy?
1. During the first trimester, dosage is 0.7 units/kg

2. From weeks 18 to 26, dosage is 0.8 units/kg

3. From weeks 27 to 36, dosage is 0.9 units/kg

4. After week 37, dosage is 1 unit/kg
What are the types of insulin?
1. Rapid-acting: Lispro (Humalog) & Aspart (NovoLog)

2. Short-acting (regular): Humulin R or Novolin R

3. Intermediate-acting (NPH): Humulin L or Novolin L

4. Long-acting: Ultralente, Humulin U, or Glargine (Lantus)
When is urine testing done?
If a meal is missed or delayed, when illness occurs, or when blood glucose level is greater than 200 mg/dL
What is the fetus of diabetic women at greater risk for?
Neural tube defects

(so, measurement of maternal serum alphafetoprotein is performed between 16 and 20 weeks of gestation)
When is fetal compromise at greatest risk?
Third trimester
When should women be taught how to do daily fetal movement counts?
Beginning at 28 weeks of gestation
What are some possible postpartum complications?
1. Preeclampsia
2. Eclampsia
3. Hemorrhage
4. Infection
What can cause hemorrhage?
Mother's uterus was overdistended (hydramnios, macrosomic fetus) or overstimulated (oxytocin production)
What are the risk factors of gestational diabetes mellitus?
1. Race (Hispanic, Native-American, Asian, and African-American)

2. Maternal age over 25

3. Obesity

4. Family history of type 2 diabetes

5. Obstetric history of an infant weighing more than 4500 g, hydramnios, unexplained stillbirth, miscarriage, or an infant with congenital anomalies
When is GDM usually diagnosed?
Second half of pregnancy