Gestational Diabetes and Obesity Flashcards
What is the gold standard for treating gestational diabetes?
Insulin!!
What factors predispose someone to gestational diabetes? (9)
- maternal obesity
- a previously large baby
- unexplained perinatal loss or malformation
- family hx
- metabolic syndrome
- PCOS
- HTN
- A1c > 5.7%
- being african american, native american (populations)
How do you screen for gestational diabetes?
-
What factors make pregnancy an insulin-resistant state? (2-ish)
- increased prolactin, progesterone, cortisol
- other hormones (GH, CRH, placental lactogen)
How would you screen for gestational diabetes?
TWO STEPS:
- 1 hour glucola (50 gms glucose tolerance test)
if abnormal, then:
- 3 hour gtt
What is considered an abnormal 1 hour gtt? What is abnormal 3 hour gtt?
- 130-140 mg/dl
- >200 mg/dl
What non-medication recommendations could you make to someone with GDM?
- dietary changes
- exercise (moderate 3-5x a week), walking after meals
What medications could you use to treat someone with GDM? Which ones are first-line treatments?
- metformin (oral)
- glyburide (oral)
- insulin
What should fasting levels of glucose be?
< 95 mg/dl
What is impaired fasting glucose?
When someone’s fasting blood sugar levels are above normal range, but below diagnostic cutoff for DM (100-125 mg/dl)
What is impaired glucose tolerance?
- two-hour glucose levels of 140-199 mg/dL on the 75-g oral gtt, AND impaired fasting glucose
What are peri-partum risks to mothers with GDM? (5)
- preeclampsia
- macrosomia (LGA)
- delivery trauma
- fetal demise
- hydramnios
What are long-term risks for the mother? (2)
- developing T2D
- developing CVD
What are possible newborn complications? (4)
- shoulder dystocia
- brachial plexus injuries (from shoulder dystocia)
- birth trauma
- increased obesity and metabolic syndrome
What is the current trend in the US, regarding obesity in pregnancy?
It is increasing! As of 2015 25% of pregnant women were obese and 26% were overweight - that is significant
