do all women with pre gestational diabetes require insulin?
- almost all
how does first trimester affect blood glucose levell
- will be lower due to hormones and nausea/vomiting
- insulin requirements will be reduced
what happens with insulin requirements in the second and third trimester
- insulin requirements will need to be adjusted and possibly increased
complications of pre-gestational diabetes includes:
- fetal congenital malformations
- hypertension
- preterm birth
- Macrosomnia
- C-section
- neonatal morbidities
- perinatal mortality
why does fetal congenital malformations occur?
- poor glycemic control in early pregnancy
Gestational diabetes mellitus (GDM) is defined as
- carbohydrate intolerance that is first recognized during pregnancy
when is gestational diabetes diagnosed
- second trimester (24-28 weeks)
risk factors for developing GDM are
- Maternal Age (over 25)
- obesity
- Macrosomnic baby (previous birth)
- multiple pregnancies
- Ahistory - family or previous diagnosis
- PCOS
risks of GDM include
- macrosomia, associated risks to labour and birth (labour dystocia, shoulder dystocia, birth trauma)
- neonatal hypoglycaemia
risk factors for overweight and obese women during pregnancy
- GDM
- hypertension
- infections
- preterm delivery
- c-section
- clots
- congenital abnormalities
poor glycemic control is associated with:
- miscarriage
- congenital abnormalities
- respiratory distress
- still birth
first priority for women with pre-gestational diabetes is
- pre-conceptual counselling (glycemic control)
care for a women with pre-gestational diabetes include:
- strict glycemic control
- freq self-monitoring of blood glucose
- pharm therapy (insulin/oral agents)
- more prenatal visits
first trimester screening includes
- measuring A1C
- or fasting blood glucose
preferred approach to diagnose gestational diabetes is
- giving 50g glucose and if blood sugar measures <7.8 post 1 hour then normal
- if blood sugar is between 7.8-11 then give 75g and if one value is met then GDM is diagnosed
- give 50g and if BS is greater than 11.1 then GDM
what are the three measurements after giving the 75g glucose for diagnosing GDM?
- FPG > 5.3
- 1hPG >10.6
- 2hPG >9.0
how is strict glycemic control carried out
- dietary modifications
- moderate exercise
- self monitoring blood sugars (before/after meals and bedtime)
when should birth be considered
- 39-40 weeks if fetal and maternal well-being is established
What were some helpful strategies women employed to adjust to their new dietary requirements?
Planning meals, preparing food ahead of time, taking meals and snacks to work, exercising after a meal, and drinking more water.
What is a key factor in a woman’s ability to successfully manager her GDM care?
- Support from partner and health care providers.
what challenges may occur when caring for an obese women
- difficulty visualizing fetus on US
- difficulty performing Leopold maneuver
- palpating contractions
- challenges with anesthesia and inserting epidural Catheter
what data would indicate a macrosomia fetus
- SFH
- high presenting part
- failure for presenting part to descend
- increased maternal wight
infants are at increased risk for
- birth trauma
- perinatal asphyxia
- preterm
- respiratory distress syndrome
- hypoglycaemia
- hyperbilirubenemia
when should blood glucose checks be done on infants?
- 2 hours of age after an effective feed
