Gestational Diabetes Mellitus Flashcards
(29 cards)
Why is GDM clinically important?
- It’s common and becoming more common
- Adverse pregnancy outcomes
- It’s easy and cheap to Dx and Tx
- Long-term health implications are costly
What’s Diabetes?
Series of conditions associated w hyperglycemia and caused by defects in insulin secretion and/or action
What are the 4 major types of DM?
- Type 1 DM
- Type 2 DM
- GDM
- Specific types of DM (Cystic fibrosis, Steroid use, Pancreatitis)
What’s GDM?
Diabetes occurring in pregnancy that is not clearly overt diabetes
What’s the Pederson Hypothesis?
- Maternal Hyperglycemia
- Fetal Hyperglycemia
- Fetal Hyperinsulinism
- Fetal Macrosomia
What’s the prevalence of GDM?
- 16.6% Pregnancies affected by diabetes
- 84% of that 16.6% is GDM
- The rest is DM T1 or T2
What are the 3 Modifiable risk factors of GDM?
- BMI >30 kg/m2 or significant WG in early adulthood and between pregnancies
- Excessive gestational weight gain during first 18-24 weeks
- HDL <0.9 mmol/L, triglycerides >2.82 mmol/L
What are the 3 Red Flags for risk factors in GDM?
- Previous unexplained perinatal loss or birth of a malformed infant
- Glycosuria at the first prenatal visit
- Multiple gestation
What are the 6 Non-Modifiable risk factors in GDM?
- History of glucose intolerance or GDM in previous pregnancy
- Hispanic/African/ Native American, South/East Asian, Pacific islander
- Family history of diabetes, especially in first-degree relatives
- Older maternal age (>30 y/o)
- Previous birth of an infant >4000g (~9 pounds)
- Medical condition/setting associated w development of diabetes, such as metabolic syndrome, PCOS, current use of glucocorticoids, HTN/CVD, acanthosis nigricans
What patients are at lower risk of GDM?
- Young (<25 y/o)
- Non-Hispanic White
- Normal BMI (<25 kg/m2)
- No history of gluc intolerance or adverse pregnancy outcomes
- No 1st degree relative w diabetes
10-30% meet all of these criteria
What are the risks and benefits of GDM screening?
-MisDx of GDM can lead to increased anxiety, pregnancy interventions, and implementation of treatment w/o clear benefit to the mother and her offspring
-Cost-effective in populations w high prevalence of GDM and T2DM, provided that lifestyle interventions are applied
Save $1945 per patient
What’s the screening method for GDM in Ireland?
-1-Step Fasting OGTT between 24-28 weeks
-One abnormal value needed for Dx
* 0h ≥ 5.1 mmol/L
* 1h ≥ 10 mmol/L
* 2h 8.5 mmol/L
What’s the screening method for GDM in the US?
-2-Step
1) 50g 1h Glucose Challenge (random)
* < 7.1 mmol/L = No GDM
* 7.2-11 mmol/L = Further Testing Needed
* ≥ 11.1 mmol/L = GDM
2) 100g 3h Glucose Challenge (fasting)
-2 Abnormal values to Dx GDM
* 0h ≥ 5.3 mmol/L
* 1h ≥ 10 mmol/L
* 2h ≥ 8.6 mmol/L
* 3h ≥ 7.8 mmol/L
What is HbA1c?
-Glycated haemoglobin. Glucose is attached to the N-terminal valine residue of each b-chain of haemoglobin A (HbA)
-Glucose can also attach nonenzymatically to the lysine residue within haemoglobin
What are the established HbA1c ranges per trimester?
- T1: 29-37 mmol/mol
- T2: 25-35 mmol/mol
- T3: 28-39 mmol/mol
What would reduce the need for an OGTT?
Applying T2 HbA1c > 35 mmol/mol since it was able to Dx 46% of those with GDM
What are the 8 risks in GDM for the offspring?
- Stillbirth (1.5x)
- Shoulder dystocia (2-3x)
- Birth Injuries
- Macrosomia (2x)
- Hypoglycemia (5x)
- Jaundice (2x)
- Respiratory distress (1.5-2x)
- Neonatal intensive care unit admission
How heavy is a Macrosomic baby and what are the risks? (and general risks for GDM babies)
- Stillbirth
- Shoulder Dystocia / Birth Trauma
- Caesarean delivery
- Hypoglycemia
- Need NNU care
- Long-term risk of obesity
- Impaired Glucose Tolerance
- Impaired Fasting Glycemia
- Increased body fat
What are the short-term risks and the long-term risk of GDM in Mothers?
Short Term:
1. Pre-eclampsia
2. HTN
3. Caesarean delivery
4. Cholestasis of Pregnancy (itch)
5. Psychological stress
Long Term:
1. T2 DM
What did Medical Nutriotional Therapy discover for patients with GDM?
-Women with diet-treated GDM and a BMI <25 kg/m2 had similar outcomes to those with normal pregnancies of the same BMI group
-Obesity increased risk for poor pregnancy outcomes, regardless of diabetes status
What are some effects of taking Oral Hypoglycemic Agents?
- Increased maternal weight
- Increased macrosomia
- Neonatal hypoglycemia
- May be suitable for patients not willing to take insulin
What is the EMERGE Trial about?
Assess the effectiveness of using Metformin (Oral Hypoglycemic Agent) early on to reduce the effects of GDM
What are the 3 negative aspects of taking insulin for GDM?
- Expensive
- Risk of hypoglycemia
- Weight Gain
What 5 things can you do to prevent GDM?
- Lifestyle change
- Weight loss w bariatric surgery
- Metformin
- Vit D
- Myo-inositol
