Exam 2: Gestational Diabetes Flashcards
(27 cards)
What is gestational diabetes
Glucose intolerance with onset during pregnancy usually in the second or third trimester
Diagnosis of gestational diabetes (overt) at first prenatal visit
Fasting 126 mg/dL or above
HbA1c over 7%
Random glucose 200 mg/dL
Risk factors for gestational diabetes
Physical Inactivity
First degree relative with diabetes hypertension
High-risk race/ethnicity
OBESITY
PCOS
Hypercholesterolemia
Previous large infant (> 9 lb)
Smoker
History of gestational DM, hydramnios, or family history of DM
S/S of glucose intolerance (polyuria, polyphagia, polydipsia, fatigue)
When to test PT for gestational diabetes
24-28 if NO risk factors
First prenatal visit if they have risk factors
Diagnosis criteria at 24-28 weeks for gestational diabetes
One or more abnormal OGTT values
Fasting BG over 95
1 step- 75g OGTT 1 hour over 180 mg/dL
75g OGTT 2 hour over 153 mg/dL
What is the most common test done for gestational diabetes?
Three step test
Need to make sure PT is aware they will be at the appointment for 3 hours
Pathophysiology of Gestational Diabetes
Deficiency or resistance to insulin
Insulin production cannot keep up with changing insulin needs during latter part of pregnancy
Results in postprandial hyperglycemia
PTs with gestational diabetes cannot meet the demands for the ________ in insulin resulting in _______
INCREASE
Hyperglycemia
Glucose in urine causes __________
Yeast infections
Gestational diabetes effect on fetus
Larger babies (Macrosomia), worry about vaginal birth and shoulder dystocia
Therapeutic management for pre-gestational diabetes
Improve metabolic control to reduce birth defects
Lifestyle modifications
Keeping a log
Medications management for gestational diabetes
Insulin (first line therapy)
Oral hypoglycemic medications (second line)
These do not cross placenta
Maternal surveillance during pregnancy for gestational diabetes
Office visits every 2 weeks until 28 weeks then twice weekly until delivery
Urine checks at each visit (looking for glucose or protein)
HbA1c every 4-6 weeks
Kidney function, eye test (1st tri)
Fetal surveillance during pregnancy for gestational diabetes
Weekly NST after 28 weeks
Ultrasounds, fetal echo
Fetal kick counts
Lung maturity (LS ration 2:1)
Dietary teaching for gestational diabetes
Avoid dieting
3 meals and 3 snacks per day
Small frequent meals throughout day
Bedtime snack with protein and fat
Management of labor for PTs with gestational diabetes
IV normal saline or lactated ringers
50% dextrose syringe at bedside to treat hypoglycemia if on insulin
Monitor BG every 1-2 hours
Ideal: Glucose levels under 110 throughout labor
Surveillance after birth (gestational diabetes)
Monitor newborn for hypoglycemia
Skin to skin
Keep newborn warm
Monitor BG every 2-4 hours for 48 hours
Encourage chest feeding
Signs of hypoglycemia in newborn
Look for variations in heart rate (normal 110-160), jitters
Normal blood glucose for newborns
BG over 40
Education for gestational diabetes while pregnant
S/S of hypo/hyperglycemia
BG self-monitoring as directed
Drink 8-10 8oz glasses of water each day to prevent UTI
Wash hands frequently
Avoid simple sugars
Treatment: 8oz of milk and eat two crackers or take two glucose tablet
Education for gestational diabetes upon discharge
Encourage lactation
Repeat GTT 6 weeks postpartum
Patients with GDM have a greater than 50% increased chance of developing type 2 diabetes
Reduce weight
Screen every 3 years after a normal screen
When is gestational diabetes typically diagnosed?
Second or third trimester
Can you identify pre-gestational diabetes vs. gestational?
Type 1: Absolute insulin deficiency
Type 2: Insulin resistance or deficiency primarily diagnosed in adults older than 30
Gestational diabetes: Glucose intolerance with onset during pregnancy usually in 2nd or 3rd trimester
What are the possible complications of uncontrolled diabetes in pregnancy?
Macrosomia, birth trauma, electrolyte imbalances, and neonatal hypoglycemia
