26162467
Description
Flashcards by Tim Krueger, updated more than 1 year ago
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Created by Tim Krueger
about 4 years ago
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| 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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