NURS 4500 Class #3 DIABETES Flashcards
(25 cards)
What are the risk of GDM for the pregnant person and fetus/newborn
- 2x risk of hypertensive disorders (pre-eclapsia)
- Infection
- Large for geatational age
- Trauma and injuries during birth
- Macrosomia, caesarian birth, shoulder dystocia, birth trauma, prematurity
- Fetal hypoglycemia, IUGR, intrauterine fetal death, fetal lung immaturity
- Neonatal hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia
What are risk factors of developing GDM
- > = 35 y/o
- BMI of 30 or above
- Prediabetic
- High risk group
- Parents or siblings with T2DM
- Personal hx of GDM
- Previous infant > 4.0kg birthweight (macrosomia)
- Currently on corticosteroid medication
- Acanthosis nigricans or PCOS
When do we screen for GDM
24-28 weeks
*if risk factors for type 2 diabetes, screen at initial prenatal visit with A1C
*if normal result, screen GDM at 24-28 weeks with 50g OGTT
What is the normal number of
Random non fasting 50g OGTT
1hr PG ????? Is normal
Less than 7.8
When 1hr PG is greater or equal 7.8 mmol/L, what is the next step?
need to continue to step 2: 75g OGTT
What is the number of PG that is indicator pf gestational diabeter
PG of greater than or equal 11.1
What is the glocose target of GDM when fasting?
< 5.3 mmol/L
What is the glucose target after 1-hr postprandial (PP)
< 7.8 mmol/L
What is the glucose target after 2-hr postprandial (PP)
< 6.7
What is the noaml BMI
18.5-24.9
What is the normal weight gain
25-35 (lbs) / 11.5-16 (kg)
What is the FASTING glycemic target
3.8-5.2 mmol/L
What is the glycemic target 1 Hr PP
5.5-7.7 mmol/L
What is the glycemic target 2h postprandial?
5.0-6.6 mmol/L
What are the ANTEPARTUM management of GDM
- Diet
- Exercise
- Monitot blood glucose levels
- Weight gain according to BMI
+ pharmacological therapy
+ fetal surveillance
+ induction may be offered between 38-40 weeks depending on circumstance
Management of GDM during INTRAPARTUM
- Monitor glucose closely, keep between 4-7 mmol/L
- Hydration (may require IV fluids)
- Insulin may be required
- Motinoring of uterine activity & FHR
Management of GDM POSTPARTUM
- STOP insulin & diabetic diet
- Encourage chest/breastfeeding for at least 4 months!
- Should have screening for T2M during the 6 weeks to 6 months PP
- Education re: planning for another pregnancy
It’s pathogenesis is a group of metabolic diseases chracterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both
T2DM
What is the folic acid recommendation for diabetic pts
1mg daily x 3 months prior to pregnancy and for the 1st trimester, then reduce to 0l4mg for the remainder of the pregnancy
What is the optimized glucose management prior to pregnancy of pt w diabetes
A1C of less than equal to 7.05
How often should diabetic patients have prenatal visit during term 1 & 2
Every 1-2 weeks
Frequency of prenatal visit of diabetic patients during term 3
1-2x each week
When does Daily Kick counts should be started
26 weeks!
How often is fetal assessment done at 36 weeks till birth?
Every week
