High-Risk Pregnancy

When is a pregnancy considered high-risk?

• When a cocurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the mother or fetus

What is gestational diabetes mellitus?

• insulin resistance

• usually occurs around 28 weeks gestation

• caused by placental hormones

• oral medications or insulin may be required

• resolves after delivery

• does not require further blood sugar monitoring

• patient is at higher risk for Type 2 later in life (rescreen 6-12 weeks postpartum)

• does have increased risk of intrauterine demise

What happens with the baby when mom has GDM?

• have higher blood sugars and insulin levels

• extra calories → stores as fat → chunky baby

• insulin = growth hormone

  • baby will be big in general, not just chunky

• inuslin itself doesn’t cross the placenta

  • Maternal sugar crosses the placenta and triggers the baby's own pancreas to make excess insulin, which acts as a growth factor to store extra energy as fat

How does a glucose tolerance test (GTT) work?

• Step 1: 1-h (50g) oral glucose screen

  • Negative (<140 mg/dL) → routine prenatal care

  • Positive (>140 mg/dL) → Step 2

• Step 2: 3-h (100g) oral glucose tolerance test (OGTT)

  • Negative

  • Positive → two or more values are met or exceesed

    • Fasting: 105 mg/dL

    • 1-h: 190 mg/dL

    • 2-h: 165 mg/dL

    • 3-h: 145 mg/dL