Exam 3 - Gestational Diabetes

Question 1

Pathophysiology of gestational diabetes

Answer 1

Normally maternal pancreas compensates for hyperglycemia and produces more insulin to maintain balance between insulin resistant cells and higher levels of glucose

Eventually insulin-producing beta cells exhaust and insulin production is diminished –> results in elevated blood sugar

Question 2

At what point are cells most responsive to insulin during pregnancy?

Answer 2

Cells are most responsive to insulin in the first 20 weeks, so there is less circulating glucose in maternal serum

However, increasing levels of hCG cellular resistance increases –> increases maternal glucose levels

Question 3

When does insulin resistance peak during pregnancy?

Answer 3

Resistance peaks at 24-28 weeks

• Reason why we give glucose tolerance tests during this time

Question 4

Risk factors for gestational diabetes

Answer 4

• Native American, Hispanic, African American, South or East Asian
• Obesity
• Previous history of abnormal glucose tolerance results
• Previous use of steroids
• PCOS
• Heart and blood vessel disease (HTN)
• First degree relative with diabetes
• Infant weighing more than 9 pounds at birth

Question 5

Complications of gestational diabetes

Answer 5

• Fetal macrosomia (>4000 g or 8 pounds 13 ounces)
• Hypertension/preeclampsia
• Uterine growth restriction
• Pregnancy loss

Question 6

What are pregnancy complications associated with fetal macrosomia?

Answer 6

• Protracted labor
• Shoulder dystocia
• Brachial plexus injury
• Cephalohematoma
• Fecial palsy
• Fracture of clavicle
• Increased risk of c-section

Question 7

Poorly controlled glucose levels or undiagnosed maternal hyperglycemia or hypoglycemia during organogenesis preceding pregnancy is associated with risk of ___

Answer 7

Risk of congenital anomalies and pregnancy loss

Question 8

Screening and diagnosis of gestational diabetes

Answer 8

Glucose tolerance test between 24-28 weeks - time in which hormones are exerting their peak influence on insulin

• Consider assessing early during first trimester visits for at risk patients

Question 9

What other diagnostic tests should the provider order during the initial prenatal visit for high risk women?

Answer 9

• Fasting plasma glucose
• Random blood sugar
• Hemoglobin A1C

May pick up those with undetected type 1 or 2 diabetes

Question 10

Screening results: what counts as overt diabetes in terms of fasting blood glucose, A1C, and random blood sugar?

Answer 10

FBS >126 mg/dL

A1C >6.5%

RBS >200 mg/dL

Question 11

Screening results: what is considered gestational diabetes with fasting blood sugar?

Answer 11

FBS >92 mg/dL but <126 mg/dL

Question 12

If initial lab values for gestational diabetes are normal, what should the provider do?

Answer 12

Provide a 75 g 2 hour glucose tolerance test at 24-26 weeks

Question 13

What would be considered overt diabetes in terms of fasting blood sugar after a 2 hour GTT?

Answer 13

FBS >126 mg/dL

Question 14

What would be considered gestational diabetes in terms of fasting blood sugar after a 2 hour GTT?

Answer 14

GDM if one value is over

• FBS >92 mg/dL
• 1 hour >180 mg/dL
• 2 hour >153 mg/dL

Question 15

When does ACOG recommond screening for gestational diabetes?

Answer 15

50 g glucose screening test at 24-28 weeks

Question 16

According to ACOG, what would be considered overt diabetes after a glucose screening test?

Answer 16

Diagnosed if >200 mg/dL

Question 17

According to ACOG, what should the provider do if the 1 hour GTT is greater than 130 mg/dL (or >140 mg/dL)?

Answer 17

Move to a 3 hour glucose tolerance test

Question 18

According to ACOG, what would be considered gestational diabetes after a 3 hour GTT?

Answer 18

GDM if 2 values are over the following:

• FBS >95 mg/dL
• 1 hour >180 mg/dL
• 2 hour >155 mg/dL
• 3 hour >140 mg/dL

Question 19

Management of gestational diabetes

Answer 19

• Monitor blood sugar regularly
• Drink cinnamon tea
• Opt for sugar free diet