Pregnancy at Risk Pregestational issues (Gestational Diabetes)

True

T/F: The normal hormonal adaptions of pregnancy affect glycemic control, and pregnancy may accelerate the progress of vascular complications.

For women with average risk, they would be Screened at what point in pregnancy?

24 to 28 weeks' gestation

Screening for diabetes: HA1c equal to or greater than _____________ would be considered diagnostic as would a fasting plasma glucose level equal to or greater than _____________ or a 2-hr plasma glucose equal to or greater than ___________ during an oral glucose tolerance test (OGTT).

6.5%, 126 mg/dL, 200 mg/dL

Macrosomia

A condition when a baby is born very large d/t mothers diabetes.

Gestational diabetes mellitus (GDM) definition

Any degree of glucose intolerance that has its onset or is first diagnosed during pregnancy.

Gradually increase

During the 2nd & 3rd trimester of pregnancy the "diabetogenic" effect occurs which has a major hormonal effect on insulin, causing levels to do what?

Pathology of Diabetes Mellitis:

Endocrine disorder of carbohydrate metabolism Results from inadequate production or use of insulin

Hyrdamnios

Excessive amniotic fluid during pregnancy d/t fetal hyperglycemia which induces fetal polyuria. Usually occurs during the 3rd trimester.

What is the criteria that would put a woman in the high-risk category for gestational diabetes?

Hypertension, glycosuria

Effect of Pregnancy on Carbohydrate Metabolism: Second half of pregnancy

Placental secretion of hormones human placental lactogen (hPL) and prolactin (from the decidua), as well as elevated cortisol and glycogen levels, cause increased resistance to insulin and decreased glucose tolerance. This decreased effectiveness of insulin results in a catabolic (destructive) state during fasting periods, such as during the night or after meal absorption. Because increasing amounts of circulating maternal glucose and amino acids are diverted to the fetus, maternal fat is metabolized much more readily during fasting periods than in a nonpregnant woman.

Effect of Pregnancy on Carbohydrate Metabolism: Early pregnancy

Rise in serum levels of estrogen, progesterone, and other hormones stimulates increased insulin production by the maternal pancreas and increased tissue response to insulin. Thus an anabolic (building-up) state exists during the first half of pregnancy, with storage of glycogen in the liver and other tissues.

Gestational diabetes mellitus (GDM)

This is a type of diabetes diagnosed after 20 weeks of pregnancy that is clearly not a preexisting diabetes.

Pre-gestational diabetes

This is a type of diabetes that occurs in type 1 or 2 diabetics that existed before pregnancy.

Still birth Congenital anomalies of CNS, cardiac and skeletal defects. Macrosomia Hypoglycemia Respiratory distress syndrome Caudial regression syndrome

What are fetal and neonatal risks & complications when the mother has pre-gestational diabetes?

Macrosomia Birth trauma (ex: shoulder dystocia, broken clavicle, etc) Blood irregularities Glucose regulation Respiratory distress syndrome (RDS) No change in rate of congenital anomalies

What are fetal risks when the mother has gestational diabetes?

Early pregnancy loss Preeclampsia (prego complication of high BP) Hypertensive disorders Hydramnios (polyhydramnios) Ketoacidosis Hyperglycemia Hypoglycemia

What are maternal risks & complications when the mother has a metabolic disorder?

Maternal age older than 25 Obesity Family history of type 2 diabetes Previous macrosomic infant Hydramnios Unexplained still birth Miscarriage Children with congenital anomalies

What are the risk factors for gestational diabetes?

Amount of insulin decreases

What happens to insulin during the 1st trimester of pregnancy?

Strict glucose control before conception and throughout the gestational period

What is the key to having a successful pregnancy with Diabetes?

Glucose

What is the primary fuel used by the fetus that can be transported across the placenta?

The placenta

What produces hormones in the mother that inhibit the function of insulin and causes the blood glucose levels to increase?

Insulin requirements usually do this postpartum.

decrease

Until recently, oral hypoglycemic agents were not used during pregnancy. Recent research suggests what medications may be safe for women with gestational diabetes?

glyburide and metformin