Diabetes in Pregnancy
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Why is glycemic control important before and during pregnancy?
- High glucose or glycohemoglobin levels during embryogenesis are associated with high rates of spontaneous abortions and major malformations in newborns
- Increased risk for the mother to develop hypoglycemia, retinopathy, HTN, nephropathy, and CAD
- To avoid hypoglycemia in the baby at birth
What 2 counseling points are essential for wmoen with DM of child-bearing potential?
- The risk of malformations associated wtih unplanned pregnancies and poor metabolic control
- Use of effective contraception unless at good control and actively trying to conceive
What medications associated with diabetes should be discontinued prior to conception?
What are the preconception goals for glycemic control?
- Fasting: 80-110
- PPG: < 155 at 2h
- A1c: < 5%
At what A1c do complications start?
What complications of DM need consideration before pregnancy?
- Hypglycemia (increased risk to the mother)
- Retinopathy (increased rate of development)
- HTN (pre-existing or pregnancy induced)
- Nephropathy (may become permanent)
- Neuropathy (can be exaerbated and complicate DM management)
- CAD (increased risk of mortality during pg)
What is GDM?
gestational diabetes mellitus = any degree of glucose intolerance with onset or first recognition during pg whether insulin or diet modification is used for control and whether or not it persists after pg
What factors place a woman at high risk of developing GDM?
- Marked obesity
- Personal hx of GDM
- Strong family hx of diabetes
When should women at average or high risk with a negative initial screening undergo testing for GDM?
24-48 weeks of gestation
When should women at low risk of GDM be tested?
they don't require testing
Who are women at low risk for GDM?
- < 25yo
- Normal wt before pg
- No 1st degree relatives with DM
- No hx of abnormal glucose tolerance
- No hx of poor obstetric outcome
What is a one-step glucose tolerance test?
- OGTT (oral glucose tolerance test):
- 100g oral glucose load
- check BG at fasting, 1h, 2h, 3h
- Should be < 180, 155, or 140 respectively
What is a Two-step glucose tolerance test?
- Initial screening 50g oral glucose load should be < 140 at 1h
- If not do an OGTT
What are the 7 perinatal complications associated with GDM?
- Fetal macrosomia
- Neonatal hypoglycemia, jaundice, polycythemia, or hypocalcemia
What are the long-term risks of GDM?
- Increased risk to develop DM in mother
- Increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood
What are the glycemic goals during pregnancy?
- FBG < 105
- 1h PPG = 155 or less
- 2h PPG = 130 or less
How often should glycemic status be checked post-partum if glucose levels were normal?
at least every 3yrs
How often should glycemic status be checked post-partum if patient was IFG or IGT?
What medications should be avoided in pts with a hx of GDM to prevent development of glucose intolerance/DM?
- Nicotinic acid
- High-dose Niacin
How should GDM be treated?
- If BMI > 30, reduce caloric intake by 30-33%
- Decrease Cargs to 35-40% of caloric intake
- Human insulin only
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