gestational diabetes

Question 1

GDM % of diabetes in pregnancy

Answer 1

90%

Question 2

Maternal complications of GDM

Answer 2

preeclampsia
increased probability of CS
increased his kof non-GDM diabetes later in life (70%)

Question 3

neonatal complications of GDM

Answer 3

macrosomnia (PPH, operative delivery, etc)
hypoglycemia
hyperbilirubinemia
shoulder dystocia
still birth

Question 4

GDM screening 1h GTT

Answer 4

50 gm

• 24-28w
• positive 130-140 (based on local rates in the community)

Question 5

early 1h GTT

Answer 5

(<24w)

• prior GDM
• obesity (>25)
• other risk factors for GDM

Question 6

3h GTT screening

Answer 6

• only if 1h is positive
• Positive if any of the 2 values are met
• 95/180/155/140
• 105/190/165/145 (either of these are used for cut offs)

Question 7

Benefits of treatment GDM

Answer 7

lower incidence of: 
LGA
perinatal death
should dystocia
neonatal birth trauma
preeclampsia

Question 8

sugar monitoring GDM

Answer 8

fasting (95)
1-2 hour post prandial (140 1h, 120 2h)

macrosomina is more associated with post prandial more Ethan fasting

Question 9

Treatment GDM

Answer 9

1) dietary: 40% carbs, 40% fat, 20% protein

2) insulin/meds

Question 10

medical treatment of GDM

Answer 10

• insulin is 1st line, oral meds 2nd line
• oral agents: glyburide, metformin
• IM: insulin

Question 11

glyburide GDM

Answer 11

oral agent (2nd line)
Daily dose: 2.5-30mg
best used for pts with T2DM/T1DM and PCOS

Question 12

metformin

Answer 12

oral agent
GDM
associated with increased risk of PTB
Daily dose 500 mg nightly one week > 500 mg BID thereafter

Question 13

insulin GDM

Answer 13

• initial daily dose 0.7-1.0 u/kg/day

- additional added if fasting, PCs are high (95, 140 or 120)

Question 14

Fetal monitoring GDM

Answer 14

• begin at 32w for poorly controlled

- unclear with well controlled how helpful it is

Question 15

Delivery GDM

Answer 15

• well controlled A1DM: 39-40.6
• well controlled A2DM: 39-39.6
• poorly controlled 37-38.6

Question 16

dystocia increases when (GDM)

Answer 16

1% > 10% when delivered beyond 40w

600 CD needed EFW >4500 to prevent one permanent brachial plexus injury

Question 17

pp GDM

Answer 17

• increased risk problems later in life
• need to be screen 6-12w pp with 75 mg 2h GTT
• if positive, do lifestyle/dietary changes. Then annual screening for 3 years to follow