Chapter 11

Question	Answer
What is gestational diabetes	Any degree of glucose intolerance with onset or first recognition occurring during pregnancy
Class A Gestational Diabetes (White's classification)	Woman has 2 or more abnormal values on OGTT but her fasting and postprandial glucose values are diet controlled
Class B Gestational Diabetes (White's classification)	Woman was not known to have diabetes before pregnancy but now requires either insulin or oral hypoglycemics for blood glucose control
Glucose crosses the placenta? (T/F)	True
Insulin crosses the placenta? T/F	False
Around the_____ week of gestation the fetus begins to produce its own _______	Around the 10TH week of gestation the fetus begins to produce its own INSULIN
During the 1st trimester, metabolic changes occur, caused by rising levels of estrogen and progesterone. These hormones stimulate the production of insulin, causing fasting glucose levels to fall by approximately ________?	10%
As a result of normal metabolic changes. Pregnant women with _________ diabetes, are prone to ______ during the first trimester.	As a result of normal metabolic changes. Pregnant women with INSULIN-DEPENDENT diabetes, are prone to HYPOGLYCEMIA during the first trimester.
During the first trimester insulin needs ______	Decrease
During the second trimester insulin needs ______	Begin to increase
During the third trimester insulin needs ______	double or even quadruple
Insulin needs usually level off after _____ weeks of gestation	36
Day of birth: insulin needs _____	Drop drastically, approaching prepregnancy levels
Insulin needs of a non-breastfeeding mother are ______	back to normal in 7-10 days after birth
The insulin needs of a breast feeding mother generally return to normal after _______	Weaning
Breastfeeding causes a _____ in insulin needs	decrease
Target blood glucose during pregnancy Fasting	60-105 mg/dL
Target blood glucose during pregnancy 1 hr postmeal	less than 140
Target blood glucose during pregnancy 2 hr postmeal	less than 120
Target blood glucose during pregnancy 2 am to 6 am	above 60
When is hyperglycemia most likely to be identified in relation to meals, and why?	2-hours postmeal, blood glucose levels peak ~2hrs after a meal
Signs and symptoms hypoglycemia	TIRED tachycardia irritability restless excessive hunger diaphoresis
No increase in risk of birth defects has been found among infants of woman who develop GDM after the first trimester. Why?	Critical period of organ formation has already passed
A BMI of _____ also contributes to the development of congenital defects even without GDM	greater than 30
Care management for GDM includes:	Screening for GDM (early for those with strong risk factors, and at 24-28 weeks gestation in general)
Indicators that warrant early GDM screening include:	BMI over 30 Hx of GDM in previous pregnancy Family Hx of diabetes Hx of macrosomic stillborn Hx of infant over 4500g
Screening for GDM consists of a 50g glucose load followed by a plasma glucose test 1 hr later. Fasting not required. What is considered a positive result?	a glucose value of 130-140 or higher
In cases of a positive GDM screen, a 2step test is performed. In the 2nd step, a 100g glucose load is delivered and followed with a 3hr oral glucose tolerance test (OGTT) Positive 3hr results include:	3hr mark 140 or above 2hr mark 155 or above 1hr mark 180 or above
24-28 week screening consists of a 75g OGTT and is considered positive if ....	One value is met or exceeded Fasting (pre 75g glucose load) 92 mg/dL 1 hr 180 mg/dL 2 hr 153 mg/dL
Antepartum interventions for GDM include	diet & exercise monitoring blood glucose pharmacological therapy fetal surveillance
Antepartum blood glucose goals for GDM are	fasting 65-95 1 hr post meal 130-140 max 2 hr post meal less than 120
Antepartum dietary goals for GDM arm	standard diabetic 30 kcal/kg/day Carbs not to exceed 50% caloric intake
Pharmacologic therapy for GDM includes	insulin therapy if fasting exceeds 95, or 2hr exceeds 120 Oral hypoglycemics in patients unwilling to comply with insulin, or not mentally competent
What is the preferred oral hypoglycemic in GDM patients?	Glyburide, only minimal amounts cross the placenta and blood glucose control in moderate GDM matches insulin
Does metformin cross the placenta?	Yes, although disturbance of the fetus has not been recorded. It is often used in place of glyburide.
Fetal surveillance is recommended in which GDM patients	Severe GDM Hypertension hx of stillbirth suspected macrosomia
Fetal surveillance consists of	twice weekly fetal nonstress test (NST) beginning at week 32 of gestation
Intrapartum interventions for GDM include	Hourly glucose monitoring insulin infusion avoiding dextrose solutions (D5W etc)
Intrapartum blood glucose goals are	80-120 mg/dL
Is GDM an indicator for cesarean birth?	Not by itself, but cesarean birth may be indicated in the presence of preeclampsia or macrosomia
What are some postpartum risks for GDM patients?	35-75% risk of GDM in next pregnancy 35-60% chance of type 2 DM in next 20 years
Most women's blood glucose_____________after birth involving GDM	returns to normal levels
What is macrosomia	a child born over 4000 g (8lbs 13ozs) greater than 90th percentile

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