GDM special populations

what is the incidence of pregestational diabetes

1%

what percent of women will develop GDM

3-8%

what is the definition of gestational diabetes mellitus 

glucose intolerance with the onset or first recognition during pregnancy 

what hormones are associated with increased insulin resistance during pregnancy 

estrogen 

progesterone 

when is insulin first present during gestation

9-12 weeks

does maternal insulin cross the placenta

no

what is insulins impact on fetal growth hormone

increase levels 

how does glucose cross the placenta

facilitated diffusion

what does glucose crossing the placenta cause

fetal hyperglycemia

fetal pancreatic B cells stimulated

end result is hyperinsulinism

what can fetal hyperglycemia cause in the first trimester 

congenital malformations

macrosomia

neonatal morbidity 

neonatal jaundice and severe hypoglycemia 

predisposition for diabetes later in life 

what is fetal macrosomia

9 lbs 4 oz or larger at birth

what are some risk factors/characteristics of fetal macrosomia

greater total body fat

greater shoulder and UE circumference

greater extremity skin fold measurements

risk of erbs palsy

how should we think of hypoglycemia in babies/newborns 

overshoot mechanism 

baby used to maternal glucose so lots of insulin in produced 

when baby is born there is no longer glucose but insulin rmains high causing hypoglycemia 

what can hypoglycemia cause

seizures

coma

brain damage

describe polyhydraminos

amniotic fluid volume under 2000mL

occurin in 10% diabetics

increased risk of placental abruption and preterm labor

what percent of miscarriages had mothers with poor glycemic control 

44% 

is the frequency of miscarriages related tot eh degree of maternal glycemic control

yes

what are adverse events associated with GDM

preeclampsia risk 4x greater

infections

c-section delivery

injury to birth canal

post partum hemorrhage

diabetes later in life

what is diabetic ketone acidosis due to 

increasingly resistant DM

occurs when body cannot use sugar because of lack of insulin 

fat used for fuel instead 

what is the byproduct of fat breakdown

ketones

what are some conditions/adverse events mothers with GDM may suffer from

increased incidence of UTI

diabetic retinopathy, neuropathy, nephropathy

what is a normal finding in a glucose challenge test 

<140 mg/dl 

does a glucose challenge test require fasting

no

what are normal values dependent on for a glucose tolderance test

1 hr <180

2 hr <155

3 hr <140

what are treatments for GDM 

diet 

insulin typically 

oral hypoglycemic agents 

what is obsterical management of GDM

series of ultrasound to monitor fetal growth

monitor fetal movements

when can a mother with GDM deliver a baby at term

if blood glucose is stable

what happens at delivery if mothers blood glucose is not stable 

c-section 

how long is the mother monitored post partum if they had GDM

6 weeks

then blood sugar should return to normal