OB-DM in pregnancy

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choward04
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OB-DM in pregnancy
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2013-05-24 10:32:12
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  1. What are 6 risk factors for GDM?
    • 1. Ethnicity
    • 2. AMA
    • 3. Fm Hx
    • 4. Unexplained stillbirth, congenital anomaly, or macrosomnia
    • 5. maternal obesity
    • 6. HTN
  2. If develops GDM, what's the risk of developing DM in next 10-20years?
    -35-60%
  3. T or F.  Pregnancy is a diabetogenic state (even when not diabetic).
    True--> pregnancy causes increase in insulin resistance by (50-60%)
  4. Increase insulin release from B-cells promotes _________________.
    lipolysis
  5. T or F.  There is a close correlation between fetal glucose uptake and maternal blood levels.
    True
  6. What are 2 problems associated with pre-existing DM on fetal growth?
    • 1. fetal growth delay (~6 days, proportional to degree of hyperglycemia)
    • 2. Glucose fluctuations >normal
    • **increase fetal glucose make pancreas work harder
  7. Hgb A1C >10 creates a potential for malformation at what percent?
    50%
  8. According to White's classification, which populations make up the classes A1, A2, B, C?
    • A1- newly diagnosed GDM w/out insulin
    • A2- newly diagnosed GDM needing insulin
    • B- Adult onset DM with insulin use
    • C- juvenile onset DM with insulin use

    (others are associated with complications from aging w/ DM)
  9. What are Pedersen's Bad signs of pregnancy?
    • 1. Pyelo
    • 2. Ketoacidosis
    • 3. PIH
    • 4.. Delay/inadequate prenatal care
  10. What is the Carpenter-Coustan fasting BG normal?
    <95
  11. What's the normal for Carpenter-Coustan's 3hr at 1hr, 2hr, 3hr?
    • 1hr- <180
    • 2hr- <155
    • 3hr- <140
  12. What glucose level is automatically considered abnormal with a GTT?
    >190 (any reading)
  13. T or F.  Retinal disease at baseline strongly is strongly predictive of adverse fetal/maternal outcomes
    True (although long-term effects probably minimal)
  14. T or F.  DM unable to increase filtration rate
    True
  15. What are 3 complication of nephropathy in severe DM disease.
    • 1. Infant survival high
    • 2. Maternal kidney damage probably & obstetric complication increase
    • 3. HTN, PIH, pre-eclampsia
  16. Dm ketoacidosis is most commonly precipitated by _______________.
    Infection
  17. Name 7 complications related to GDM pregnancies.
    • 1. PTL
    • 2. Infection
    • 3. HTN & consequences
    • 4. Stillbirth
    • 5. DM retinopathy
    • 6. Polyhydramnios (PTL, PROM, unstable lie, cord prolapse)
    • 7. C/S rate
  18. What are some fetal effects from GDM pregnancies?
    • 1. Asphyxia
    • 2. Birth injury
    • 3. congenital malformation (caudal regression)
    • 4. HF
    • 5. Cardiomyopathy
    • 6. Increased blood vol.
    • 7. Neuro instability
    • 8. Organomegaly
    • 9. Polycythemia
  19. Congential malformations usually occur from insults < ___________ weeks.
    7 weeks

    (30-50% of perinatal deaths are caused by malformations
  20. What CNS and cardiac malformations have high occurance in infants of Type I moms?
    • -CNS: (15x) ancephaly, spina bifida
    • -Cardiac: (18x likely) VSD, transposition
  21. Increased glucose, ketones, & episodes of hypoglycemia predispose to congenital malformations  by what 2 processes?
    • 1. Inhibition of glycolysis (needed for embryogenesis)
    • 2. Functional deficiency of arachidonic acid (CNS defects)
  22. What are fetal/neonatal problems associated with GDM?
    • 1. Congenital malformation
    • 2. hypergilirubinemia/polycythemia
    • 3. Neonatal hypoglycemia
    • 4. Macrosomia
    • 5. IUGR
    • 6. Respiratory distress
    • 7. death
  23. What is fetal polycythemia bad?
    -Causes relative hypoxia in utero
  24. What blood glucose level significantly increases fetal problems in L&D.
    - >90 mg/dl
  25. Why is uncontrolled blood sugar an issue in late pregnancy?
    -Increase fetal hyperglycemia causes B-cel proliferation in fetal pancreas
  26. What are 7 bad outcomes of macrosomnia?
    • 1. shoulder dystocia
    • 2. brachial plexus injury
    • 3. Hyperbilirubinemia
    • 4. Hypoglycemia
    • 5. neonatal acidosis
    • 6. asphyxia
    • 7. increased risk for obesity & DM in later life
    • ***tight control may not help
  27. T of F.  Tight control of blood sugar can almost eliminate RDS
    T--> hyperglycemia delays pulmonary maturation
  28. What is the hypothesis for increased (3x) fetal death in DM?
    -increased insulin with increased oxygen demand and decreased uterine blood flow results in insufficient uteroplacental blood flow
  29. What are 5 risk factors for fetal death after 36 weeks in DM moms?
    • 1. Poor glycemic control
    • 2. Pre-E
    • 3. Hydramnios
    • 4. Fetal macrosomnia
    • 5. vascular disease
  30. What is the general BG level you want to keep DM women at during pregnancy?
    120 or below

    • **2000-2500cal/day
    • **careful monitoring in 3rd trimester
    • ** daily glucose monitoring (daily & 2hr p meals)
  31. Therapeutic objectives for BG are:
    • FG---> 60-90
    • 2hr after meal --> <120
    • Monitor A1c
  32. Why should 1st gen sulfonylureas not be given to DM moms?
    -cross placenta and stim fetal insulin secretion and have profound hypoglycemia at birth
  33. T or F. Insulin requirements may drop initially and slowly increase until 20 weeks
    True
  34. When do insulin needs accelerate during pregnancy?
    after 26 weeks
  35. How often should retinal exams be performed in a pregnant women with established disease?
    monthly

    **Once or each trimester is no disease initially
  36. T or F. Is glyberide a clinically effective alternative to insulin therapy.
    True
  37. When is a sonogram performed to assess for congenital anomaly?
    18-22 weeks
  38. How many times should a DM receive NST (starting 32-34)?
    2x weeks
  39. What are you assessing for during U/S in late pregnancy?
    • -Fetal growth
    • - estimating fetal weight
    • -detecting hydramnios
    • -deteching malformations
    • -focus on ABDOMINAL CIRCUMFERENCE (most predictive of fetal macrosomnia
  40. When should BPPs start being performed?
    -weekly after 36 weeks
  41. If a mom's BPP is "positive", what is the plan of care?
    -Amnio if preterm, or delivery
  42. To decrease the risk of neonatal hypoglycemia, how should glycemic control be maintained during labor?
    IV insulin (D5 drip as needed). Monitor BG q 1 hr
  43. What happends to glucose levels right after delivery?
    Insulin requirement immediately drop towards pre-pregnancy needs. BF decreases this another 25%.
  44. What labs should be verified at the 6 week postpartum check for gestational DM?
    • Check A1C (normal < 7.5)
    • 75mg oral GTT (normal 1&2hr <200)
    • FBG <140

    **evaluate q 3-5 years, check renal function, TSH, DM complications

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