16: Medical Conditions in Pregnancy

Question 1

Gestational diabetes

Answer 1

Glucose intolerance recognized during pregnancy

Question 2

Screening for GDM

Answer 2

Between weeks 24-28; 50gm one hour oral load glucose challenge, followed by 3 hour 100 gm oral load glucose tolerance test

Question 3

Abnormal values for oral glucose tests

Answer 3

Greater than 130-140; patient fails 3 hour test with 2 or more abnormal values

Question 4

Risk factors for GDM

Answer 4

Obesity, hx GDM, stromg Fhx of DM, known glucose intolerance

Question 5

Maternal complications of GDM

Answer 5

Increased risk of gestational HTN, preeclampsia, C-section, later development of DM

Question 6

Fetal complications of GDM

Answer 6

Macrosomia, neonatal hypoglycemia, hyperbilirubinemia, operative delivery, shoulder dystocia, birth trauma

Question 7

Maternal complications of pregestational diabetes

Answer 7

Worsening nephropathy/retinopathy, increased risk of preeclampsia, greater risk of DKA

Question 8

Fetal complications of pregestational diabetes

Answer 8

increased risk spontaneous abortion, growth defects, growth restriction and prematurity

Question 9

Parameters for good glycemic control during pregnancy

Answer 9

Fasting glucose less than 90 mg/dL

2 hour postprandial less than 130 mg/dL

Question 10

Anti-thyroid medications in pregnancy

Answer 10

1st trimester: PTU

2nd and 3rd trimesters: Methimazole

Question 11

Maternal hyperthyroidism affects on fetus

Answer 11

Medications can cross placenta and cause fetal hypothyroidism, fetal goiter can develop

Question 12

Risks to fetus of untreated maternal hypothyroidism

Answer 12

Spontaneous abortion, preeclampsia, abruption, low birth weight, stillbirth, lower intelligence