Gestational Diabetes

Question 1

Definition of GDM

Answer 1

Any degree of glucose intolerance with onset or first recognition during pregnancy

Question 2

A1 GDM

Answer 2

GDM managed with lifestyle/ nutritional therapy (responsive)

Question 3

A2 GDM

Answer 3

GDM managed by medication (insulin)

Question 4

Main hormone implicated in GDM

Answer 4

human placental lactogen

Question 5

Other hormone implicated in GDM

Answer 5

Progesterone, Prolactin, placental section growth hormone, and Corticotropin releasing hormone

Question 6

Risk factors for GDM

Answer 6

A. Obesity (>25 BMI)
B. Advance Age (>30)
C. Family history of DM
D. Previous GDM

Question 7

Pathophysiology of Macrosomia

Answer 7

Maternal hyperglycemia -> fetal hyperglycemia -> stimulates fetal pancreas -> anabolic properties of insulin -> increase fetal tissue growth -> macrosomia

Question 8

If pxt is low risk at prenatal check up, what do you do?

Answer 8

Schedule OGTT screening at 24-28 weeks

Question 9

What makes Filipino immediately at high risk?

Answer 9

Population - Pacific Islanders

Question 10

When is infant considers macrosomia?

Answer 10

For Over Diabetes: >4500g
For GDM: >4000g

Question 11

Non-pharmacologic management for GDM

Answer 11

Diet, Isometric Exercise, and CBG monitoring

Question 12

When would you begin to prescribe Insulin?

Answer 12

When non-pharmacological management does not suffice.

Question 13

What FBS level is used as the threshold to diagnose overt diabetes

Answer 13

126 mg/dl

Question 14

When should you screen for Type 2 DM in Pregnant Filipinos?

Answer 14

At first prenatal visit

Question 15

What would you use to screen for type 2 GDM

Answer 15

Either FBS, Glycosylated Hb, or RBS

Question 16

Screening cut-off for Overt Diabetes

Answer 16

FBS: >/= 126 mg/dl
RBS: >/= 200 mg/dl
HbA1c: >/= 6.5%
OGTT (75g, 2hr): >/= 200/dl

Question 17

Screening cut off for GDM

Answer 17

75g OGTT (2hr)
A. FBS: >/= 92 mg/dL
B. 1hr: >/= 180 mg/dL
C 2hr >/= 153 mg/dL or 140 mg/dL

Question 18

Screening follow up: No risk Factors w/ normal FBS/RBS/HbA1c

Answer 18

OGTT @ 24-28 weeks

Question 19

If follow up screening at 24-28 weeks is normal, what happens next?

Answer 19

Screening at 32 weeks or earlier if with signs

Question 20

Katniss is diagnosed with gestational diabetes that is controlled solely
with diet. Which of the following are important for the management of
her pregnancy at term?
A. Induction at 38 weeks’ gestation
B. Weekly umbilical artery Doppler studies
C. CS if estimated fetal weight is 3,800 grams
D. Expectant management until 40 weeks

Answer 20

D. Expectant management until 40 weeks
Expectant management until 40 weeks, but not beyond 40 weeks. Early induction <39 weeks may be associated with neonatal complications.

Question 21

Timing of elective delivery

Answer 21

on or before 39 weeks

Question 22

When should elective CS be considered

Answer 22

Festus is suspected to be obese
EFW >/= 4500g

Question 23

Which of the following is a risk factor in pregnant women for impaired carbohydrate metabolism?
A. Family history of diabetes.
B. Previous infant with polycystic kidney disease
C. High serum levels of antiphospholipid antibodies
D. All of the above

Answer 23

A. Family history of diabetes

Question 24

The risk of fetal death is three to four times higher in women with which of the following conditions affecting pregnancy?
A. Type 1 diabetes
B. Type 2 diabetes
C. Gestational diabetes
D. Impaired fasting glucose

Answer 24

A. Type 1 diabetes

Question 25

Women with type 1 diabetes should achieve glycemic control with which of the following during pregnancy? A. Insulin B. Diet C. Insulin and diet D. Oral hypoglycemic agents Basha, 28-year-old, G1P0 consulted for her first

Answer 25

C. Insulin and diet

Question 26

Basha, 28-year-old, G1P0 consulted for her first prenatal check-up. Past medical and family histories are unremarkable. Her HbA1c is 5.0%. Which of the following is the appropriate next steps in her follow-up? A. No need for subsequent screening for gestational DM. B. Screen at 24-28 weeks using a 2-hour 75-gram OGTT. C. If OGTT at 24-28 weeks is normal, re-test at 32-34 weeks using FBS. D. If OGTT at 24-28 weeks is normal, re-test at 32-34 weeks using 75-g OGTT

Answer 26

B. Screen at 24-28 weeks using a 2-hour 75-gram OGTT. Since she is a low-risk patient, we can simply request for the routine screening at 24-28 weeks using 2-hr 75g OGTT.

Question 27

Maternal complications for GDM

Answer 27

Diabetic retinopathy Diabetic nephorpathy Diabetic neuropathy Diabetic ketoacidosis Preeclampsia Infection Wound complications

Question 28

Fetal Complications in GDM

Answer 28

Macrosomia Polyhydramnios Spontaneous abortion Preterm delivery Malformation

Question 29

Pathophysiology of Hydramnios

Answer 29

A. Fetal hyperglycemia -> polyuria -> hydramnios B. Congenital anomaly (esopahgeal atresi) -> decrease intake of amniotic fluid -> hydroamnios

Question 30

Treatment goal for GDM

Answer 30

Preprandial/FBS:

Question 31

Treatment goal for pregnant pxt with preexisting DM

Answer 31

FBS/preprandial: 60-99 mg/dL Peak postprandial: 100-129 mg/dL HbA1C:

Question 32

Drug of choice for GM in pregnancy?

Answer 32

Insulin

Question 33

Insulin Regimen: Basal Insulin

Answer 33

1st Trimester: 0.7-0.8 units/kg 2nd Trimester: 0.8 - 1.0 units/kg 3rd Trimester: 1.0-2.0 units/kg 2/3 breakfast, 1/3 at night