Gestational DM

Question 1

What are some risk factors of GDM?

Answer 1

• maternal obsesity
• maternal age (over 25)
• previous delivary of baby larger than 9lbs
• Hx of unexplained perinatal loss or malformation
• family hx of diabetes - especially first degree relatives
• glycosuria at first pre-natal visit
• metabolic syndrome: 3 or more risk facotrs of atheroscerotic disease and T2DM
• Polycystic ovarian syndrome (chronic anovulation in the setting of obesity, hyperinsulinemia, T2DM, lipid abnormalities, hirsutism, infertility and ovarin cysts)
• hypertension
• glucocorticoid use at tiem of pregnancy
• ethnic groups with high prevalnce of T2DM (hispanic and south asians mostly)

Question 2

If a patient’s impaired fasting glucose shows 125, what does it mean?

Answer 2

indicates DM. Preddiabetes are 100-125

Question 3

If a patients IGT (impaired glucose tolerance) is 138 what does it mean?

Answer 3

They’re not not prediabetic (prediabetcis are 140-199.

Question 4

How and when do you screen someone for GDM

Answer 4

At 24-28 weeks gestation. Two approach common in US:

1. screen with 50 gm oral glucose challenge with single plasma glucose drawn at one hour (less than 130 is normal)
2. If greater than 130, then proceed with 100g oral glucose challenge in a fasting state (no caloric intake for at least 8 hours prior to test)

Question 5

During 100 gm challenage how do you determine positive test for DM?

Answer 5

You need to positive values greater than normal. The cut offs are: fasting

Question 6

a patient with glucose 122 is said to be _

Answer 6

impaired fasting glucose prediabetic. 100-125 is positive for impaired fasting flucose

Question 7

what is the result of access glucose during pregnancy

Answer 7

larger than normal fetus. the excess glucose gets stored as fat.

Question 8

what are some maternal complications of GDM

Answer 8

• still birth
• preclampisa
• large babies that can cause perineal laceration in vaginal birth and may
• hydroamnios: excess amniotic fluid in uterus
• increased long term risk for mother for T2DM and T1DM and CV disease

Question 9

what are some fetal complication of GDM?

Answer 9

• shoulder dystocia
• brachial plexus injury
• birth trauma (contusion, large hematoma from vacuum extraction , hypoxia/acidosis
• increased long term risk obesity and metabolic syndrome
• hypoglycemia
• hyperbilirubinemia