Clinical Presentation: Gestational Diabetes

Question 1

What are some risk factors for Gestational Diabetes Mellitus?

Answer 1

• Maternal Obesity (Maternal BMI over 30 kg/m2)
• Maternal Age over 25
• Previous delivery of baby larger than 9 lbs
• Family History of Diabetes
• History of unexplained perinatal loss or malformation
• Glycosuria at first pre-natal visit
• Metabolic Syndrome
• Polycystic Ovarian Syndrome
• Hispanics, African Americans, Native American, Pacific Islander have a HIGHER prevalence of T2DM (and Gestational Diabetes)

Question 2

Which of the following, would you consider most likely to predispose to Gestational Diabetes?

A. Age of 23 @ conception
B. Previous term baby weighing 7 lbs, 9 oz
C. Samoan (Pacific Islander) origin
D. Maternal BMI of 20 kg/m2
E. Paternal great aunt with Impaired Glucose Tolerance

Answer 2

C.

Question 3

When do you screen the patient for Gestational Diabetes Mellitus?

Answer 3

24-28 Weeks Gestation

Question 4

What is the two step approach most common in the US to screen for Gestational Diabetes Mellitus?

Answer 4

1. Screen with 50 g oral glucose challenge with single plasma glucose drawn for an HOUR (Less than 130 is NORMAL)
2. If greater than 130, proceed with 100 g oral glucose challenge in a fasting state (no caloric intake for at least 8 hours prior to the test)
   - 2 levels need to be elevated to have GDM
   - Fasting < 95
   - 1 hour < 180
   - 2 hour < 155
   - 3 hour < 140

Question 5

What are the glucose levels seen with “Impaired Fasting Glucose”?

Answer 5

100-125 g

Question 6

What are the glucose levels seen with “Type 2 DM”?

Answer 6

126 g or more

Question 7

Explain what happens to a baby when a mother has Gestational Diabetes Mellitus.

Answer 7

• Mother’s blood brings extra glucose to the fetus
• Fetus makes more insulin to handle extra glucose
• Extra glucose gets stored as FAT and fetus becomes larger than normal

Question 8

What are some maternal complications associated with Gestational Diabetes Mellitus?

Answer 8

1. Stillbirth
2. Preeclampsia: Proteinuria (after 20 weeks gestation) and Hypertension (>140/90)
3. Polyhydramnios: Excess amniotic fluid in uterus
   - Excess urine production because of excess glucose
4. Can result in perineal laceration in vaginal birth and may prompt C-section delivery (Macrosomia, Large for Gestational Age - LGA)

Question 9

What are some fetal complications associated with Gestational Diabetes Mellitus?

Answer 9

• Shoulder Dystocia (Brachial Plexus problems)
• Birth Trauma
• Increased long term risk of Obesity and Metabolic Syndrome
• POST-natal: HYPOglycemia and HYPERbilirubinemia

Question 10

A 28 y/o obese hispanic female delivers a baby weighing 10 lbs, 2 oz by C-Section. Which of the following would you advise the mother?

A. Subsequent babies will be normal weight
B. She has a higher risk of Type 2 DM
C. Her newborn’s blood sugar will be high after delivery
D. Her blood pressure will remain normal
E. Her newborn will maintain a normal weight into adulthood

Answer 10

B.