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Complications if hyperglycemia is untreated in the 2nd or 3rd trimester
- Fetal macrosomia
- Birth Injury
- Maternal Hypertension
- Maternal preeclampsia
- Future diabetes and/or obesity in child
Patients at high risk of GDM
- Family History
- > 40 years old
- Personal history of GDM
When do you check BG in a 50 gram OGTT and what is the level needed to continue further testing?
What are the levels for the 100 g OGTT? How many are needed for a diagnosis?
- Fasting > 95
- 1 hr > 180
- 2 hr > 155
- 3 hr > 140
- 2 of the 3 need to be met or exceeded
When should women at high risk be screened for T2DM?
At the first visit
Between 24-28 weeks gestation what test should be performed?
- 75 g OGTT
- FPG > 92
- 1 h > 180
- 2 h > 153
How many times a day should a woman with previous diagnois check her blood sugar?
- 8 x a dam
- 2 Premeal
- 3 Post meal
- 1 bedtime
- 1 nighttime
How many times a day should a woman diagnosed with GDM check her blood sugar?
- 4 times
- 1 fasting
- 3 post prandial
What are the biophysical test of fetal well being? When do these tests start?
- Fetal movement counting (at 28 weeks)
- Non-stress test (BIW)
- Contraction stress test (QW)
- Ultrasonographic profile (QW)
- Start at 28 weeks for patients with high risk and 34 for normal patients
What are the blood glucose goals of a GDM woman?
- Fasting < 95
- 1 h < 130
- 2 h < 120
What are some characterstics of gestational diabetes?
- Lower fasting levels
- Modestly elevated postprandial levels
- Maternal hyperinsulinemia
What are some consequences for the mother during pregnancy?
- Diabetic retinopathy
- Renal dysfunction
- Chronic hypertension
- Thyroid Disorder
- Cardiovascular disease
When is ketoacidosis risk greatest?
- 3rd trimester of pregnancy
- Fetal loss can occur
What are considerations for retinopathy in pregnant women?
- Check before conception
- If evident of retionpathy before conception treat with laser therapy
Will proteinuria increase or decrease in pregnancy?
- May cause chronic hypertension and complications for mother
- Increase risk of morbidity for child and mother
- Increased risk of preterm birth and fetal growth restriction
What are some possible problems for the neonate?
- Birth Injury
- Respiratory distress
At what levels should you consider adjusting the mother's medications?
- Fasting > 105
- 1 h > 155
- 2 h > 130
What are requirments for MNT in pregnant women?
- Eat 6 times a day (3 meals, 3 snacks)
- Carbs should not account for > 50% of total diet
- 2000-2200 calories per day
- Total weight gain: 22-26 pounds
What types of exercise should be avoided in pregnant women?
- Resistance training
- Lower body weight-bearing exercise
How often should they work out?
- 30 minutes most days of the week
- Walking, prenatal aerobics class, swimming
What is the only FDA approved treatment in pregnancy?
Goal post prandial blood glucose on insulin
What type of insulin has been studied the most in pregnancy?
Rapid acting-- lower risk of delayed post prandial hypoglycemia
What are indications for insulin therapy
- F > 105 AND/OR
- 1H > 155 AND/OR
- 2 HR > 130
- Two or more abnormal measurements over 1-2 weeks
Recommended insulin dosing
- 1st trimester: 0.8 u/kg
- 2nd trimester: 1 u/kg
- 3rd trimester: 1.2 u/kg
Who would most benefit from oral medications in pregnancy?What medications have shown this?
- Women with a BG between 140-180 on the first OGTT
- Metformin and glyburide
EFW < 4500
Manage according to standard practices
Counsel patient regarding trial labor
How often should you monitor finger stick BG during labor?
Every 1-2 hours
When should patients in labor be started on D52?
When expected to last longer than 6 hours
Insulin dripd uring labot?
If FSBGs are > 120