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