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20 Cards in this Set
- Front
- Back
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Definition of gestational diabetes
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Carbohydrate intolerance with onset or first recognition during pregnancy
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Time for first screening of GDM
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Screen at 24-28 weeks
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Method of screening for GDM
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50g oral glucola ingested with no preparation
Measure plasma glucose level If above threshold, go to 3 hour glucose tolerance test 2 elevated values required for GDM diagnosis |
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Indications for second screen at 32-34 weeks
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Positive screen at 24-28 weeks
Maternal age > 33 Maternal obesity Single elevated value on glucose tolerance test |
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Classification of GDM
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A-1 - mild, diet therapy alone
A-2 - severe, use diet with glyburide or insulin |
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Dietary management of GDM
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Adjust calories for ideal body weight
Compliance is key Dietary restriction predisposes to ketosis in obese people, so don't calorie restrict Carbohydrate restriction can improve glucose control and reduce newborn complications |
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Exercise in diabetes
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Can be beneficial
Avoid mechanical stress on trunk Monitor uterine activity |
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Diabetogenic factors in pregnancy
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Human placental lactogen
TNFa - causes insulin resistance |
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Sulfonylurea drugs (glyburide)
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Increase insulin secretion
Decrease glucose production Improve insulin sensitivity Doesn't get into fetus |
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Maternal complications in gestational diabetes
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HTN
Polyhydramnios UTI - group B strep Macrosomia Pre-eclampsia Fetal risk parallels glycemic control |
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Indications for antepartum evaluation
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Class A2 GDM
Pre-eclampsia History of stillbirth Insulin use in previous pregnancy Poor glucose control |
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Antepartum testing
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Twice daily maternal assessment of fetal activity
Weekly or bi-weekly non-stress testing starting by 34-36 weeks |
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Early delivery in GDM
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Reduces macrosomia
Predisposes to RDS Increases failed induction |
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Late delivery of GDM
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More spontaneous labor
Increased fetal distress Higher stillbirth rate More meconium |
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Intrapartum management
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Higher group b strep colonization
Glucose analysis in type A2 patients |
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Delivery management
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C-section is elevated
Macrosomia resulting in shoulder dystocia at vaginal delivery |
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Fetal risks with GDM
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Hypoglycemia
Hypocalcemia Hypomagnesemia Polycythemia RDS Hyperbilirubinemia Low cord pH Cardiomyopathy |
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Post-partum management of GDM
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Breast feeding encouraged
Test for glucose intolerance at 6 weeks and yearly High recurrence rates |
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Contraception for women with GDM
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Low-dose OCs
Avoid progestin-only OCs |
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At-risk population
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>25 years old
Ethnic or racial group with high prevalence of diabetes Obese Family history of diabetes |
