Term
| Carbohydrate intolerance of variable severity with onset or first recognition during pregnancy |
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Definition
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Term
| incidence increasing as obesity increases |
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Definition
|
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Term
| What are some potential problems for GDM? |
|
Definition
Macrosomia
–– Operative birth
– Birth trauma
• Preeclampsia
• Diabetes and obesity in offspring
• Neonatal hypoglycemia
• Increased perinatal morbidity and mortality |
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Term
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Definition
| Variously defined as birth weight > 4000gms, >4500 gms, or >90% for gestational age |
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Term
| What is the number one way to reduce morbidity associated with GDM? |
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Definition
| Glycemic control reduces risk of all the above |
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Term
| Increased glucose leads to increased |
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Definition
|
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Term
| Review the Physiology of GDM |
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Definition
Insensitivity to insulin, know as insulin resistance→→
• Excess glucose carried to fetus →→
• Fetal pancreas reacts by producing extra insulin →→
• Stimulate glycogen storage →→
Excess glucose stored as fat →→
• Fetal macrosomia |
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Term
| what is the timing for screening for GDM?rationale ? |
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Definition
Serum screen @ 24-28 weeks
– Diabetogenic effects of pregnancy are present at this point in gestation |
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Term
| What women are dx with overt diabetes during pregnancy? |
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Definition
High risk women found to have diabetes at the 1st visit receive a diagnosis of overt
diabetes, not GDM |
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Term
| What are the screening parameters for women with high risk for GDM? |
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Definition
Screen at 1st visit or as soon as feasible
– Repeat @24-28 weeks if negative |
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Term
| Women found to have diabetes at their first prenatal visit are considered to have |
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Definition
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Term
| The threshold value for the 1hr GTT is |
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Definition
| Threshold values range from 130-140 |
|
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Term
| what value is dx for GDM with a 1hr GTT? |
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Definition
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Term
| Measures the % of hemoglobin that is coated with sugar (glycosolated) |
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Definition
|
|
Term
used in women at high risk who are diagnosed for the 1st time with DM at the 1st
visit |
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Definition
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Term
|
Definition
| Increased cellular resistance to insulin due to pregnancy changes, |
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Term
| If pt has good glycemic control during pregnancy, what can she expect for her pregnancy outcome? |
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Definition
her pregnancy course is most likely WNL
• Goes away for most women after birth |
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Term
| Reveiw dietary management for GDM |
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Definition
Often referred to dietician, still need
immediate diet counseling by midwife
• Carbohydrates limited to 35-40% of diet
• Eat less carbohydrate at breakfast than at other meals: this is when insulin resistance is the
greatest
• Eliminate refined sugars (cake, cookies, pies, soda etc)
• 3 meals plus 2 snacks
• Choose foods high in fiber (fruit, whole wheat and grains)
• Avoid ketosis |
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Term
| Reveiw exercise management for GDM |
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Definition
Regular exercise increases the efficiency of insulin
• Some studies show this to be just as effective as diet
• This is an important part of teaching & discussion!
• Brisk walking, swimming, biking daily 20-30 minutes |
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Term
| Home glucose monitoring should occur how often? |
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Definition
|
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Term
| FBS and 2 hour postprandial after each meal readings are expected to be |
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Definition
|
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Term
| Fetal survellience of mothers with good glycemic control |
|
Definition
FMC at 34-36 weeks
– Biophysical profile 2X’s/week starting 40 weeks
– Await spontaneous labor, typically up to 41 weeks |
|
|
Term
| what are the risk factors for development of DM later in life? |
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Definition
Obesity
– Early gestational age at diagnosis of GDM
– Degree of abnormality of postpartum glucose tests. |
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Term
| When is it normal to find fFN in the vaginal and cervical secretions? |
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Definition
| prior to 16-20wks and at term labor |
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Term
| FGR is linked to what adult health complications? |
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Definition
| HTN, stroke, and kidney disease |
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Term
| At what gestation should women begin progesterone thearpy for tx of PTL? |
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Definition
|
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Term
| when is vaginal progesterone appropriate? |
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Definition
| without a hx of ptl or birth, but incidental finding of short cervix |
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Term
| FGR is caused by placental abnormalities such as |
|
Definition
| abnormal placentation, incomplete adherence or trophoblastic invasion, placental site hypoperfusion, and others |
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Term
| review risk factors for IUFD |
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Definition
| placental problems, poor fetal growth, infections, chronic maternal health problems, cord accidents |
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Term
| Certain risk factors also are associated with stillbirth. Some of these include |
|
Definition
Maternal age over 35
Maternal obesity
Multiple gestation (twins or more)
African-American ancestry |
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Term
| The CDC recommends that all pregnant women receive how much iron? |
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Definition
| 30 mg of supplemental iron. |
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Term
| Diagnostic tests for IDA include__________. A serum ferritin confirms ________. |
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Definition
| Diagnostic tests include a CBC with indices. A serum ferritin confirms iron deficiency anemia |
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Term
| Pregnancy enhances GI absorption of what nutrient? |
|
Definition
|
|
Term
| know the values for H and H that indicate anemia in pregnancy? |
|
Definition
1st and 3rd trimester: 11 and 33%
2nd trimester: 10.5 and 32% |
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|
Term
| Hemodilution during pregnancy is caused by an |
|
Definition
| increase in plasma blood volume: 1000ml total blood volume |
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Term
|
Definition
|
|
Term
| what is the lifespan of a Hbg-S? |
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Definition
|
|
Term
| what are complications of a sickle cell disease? |
|
Definition
| vaso-occlusive crisis, infection, necrosis, acute or chronic pain |
|
|
Term
| How is sickle cell disease diagnosed? |
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Definition
| the most common test is a hbg electrophoresis |
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Term
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Definition
|
|
Term
| sickle cell trait is associated with |
|
Definition
| increased asymptomatic bacteriuria and UTI |
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Term
| AA women with sickle cell trait have increased risk of |
|
Definition
| VTE when using hormonal contraceptives. |
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Term
| Thalassemia alpha is caused by a |
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Definition
| partial deletion or complete deletion of the alpha chain of hemoglobin |
|
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Term
| what groups most often have thalassemia? |
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Definition
| those with African or Asian decent |
|
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Term
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Definition
| rbc evaluation; hypochromic and microcytic and the hgb level is depressed |
|
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Term
| what causes beta thalassemia? |
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Definition
| impaired beta globin chaining or alpha chain instability |
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Term
| How do you tx thalassemia? |
|
Definition
| iron and folate supplements |
|
|
Term
| megaloblastic anemia is rare in the US but is most often caused by |
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Definition
|
|
Term
| megaloblastic anemia is most often seen in women who do not consume enough |
|
Definition
| green leafy veggies, legumes, or animal protein |
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Term
| As megaloblastic anemia worsens so does |
|
Definition
|
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Term
| Dx of megaloblastic anemia is |
|
Definition
| low plasma folic acid concentration and peripheral blood smear that demonstrate macrocytes. |
|
|
Term
| magaloblastic anemia is difficult to dx when there is concurrent |
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Definition
|
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Term
| tx of megaloblastic anemia includes |
|
Definition
| folic acid, iron supplements, and dietary changes |
|
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Term
| caused by a cluster of IgG antibodies directed against one or more platelet gylcoproteins |
|
Definition
| idiopathic thrombocytopenic purpera (ITP). |
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Term
| In ITP, platlets which are covered in antibodies are |
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Definition
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Term
| ITP has been associated with |
|
Definition
| lupus, lymphomas, leukemia, and other systemic diseases |
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Term
| When should tx of ITP take place? |
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Definition
| when platlet counts are less than 30-50k |
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Term
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Definition
|
|
Term
| gestational thrombocytopenia can be |
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Definition
|
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Term
| if ITP does not resolve with conventional tx the other alternative is |
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Definition
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Term
| Gestational thrombocytopenia is most likely due to |
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Definition
| hemodilution and increased splenic mass |
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Term
| MCV volume greater than 100 indicate |
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Definition
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|
Term
| MCV greater than 115 almost always indicates |
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Definition
|
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Term
| B12 deficiency is most often caused by _____ or in those who have had_____ |
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Definition
| crohn's disease or gastric resection |
|
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Term
| What is the most protective factor for development of GDM? |
|
Definition
|
|
Term
| What are risk factors for GDM? |
|
Definition
| race, first degree relative with diabetes, hx of GDM, women who's own birth weight was less than 2500g, hx of macrosomic baby, hx of bad outcome in pregnancy, and hx of stillbirth |
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Term
| IDA is associated with what affects on the nenonate? |
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Definition
|
|
Term
| What maternal complications have been implicated with increased Iron supplementation? |
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Definition
|
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Term
| A short cervix found in the early or late 2nd trimester has been associated with______ptl. |
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Definition
|
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Term
| What are things that women can do to decrease the risk of ptl or birth? |
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Definition
| improved weight gain and nutrition, improved dental care prior to pregnancy, avoiding cocaine or smoking, dx and tx of asymptomatic bacteriuria, reduced occupational fatigue, and use of progesterone |
|
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Term
| what doubles the occurance of ptl and birth? |
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Definition
| ow pre-pregnancy weight....<19.8% |
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Term
| Women who eat less than 3 meals per day and two snacks are at increased risk for |
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Definition
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Term
| A short cervical length is usu defined up to ____wks gestation but may be dx up to ____wks gestation. |
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Definition
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Term
| Where is fetal hemoglobin located? |
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Definition
|
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Term
| What type of anemia can affect the fetus due to the location of fetal hemoglobin? |
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Definition
|
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Term
| Vaginal progesterone is indicated prior to 24wks when the cervix is _____mm in length. |
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Definition
|
|
Term
| women over the age of 30 are at higher risk for |
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Definition
|
|
Term
| What are common problems in women who have a multi fetal pregnancy? |
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Definition
| inadequate nutrition, GDM, pre-e, and PTL, |
|
|
Term
| symmetrical FGR occurs during earlier gestation and is associated with |
|
Definition
| severe infection and chromosomal abnormalites |
|
|
Term
| asymmetrical FGR occurs during the later parts of pregnancy and is associated with |
|
Definition
|
|
Term
| Which FGR is most common? |
|
Definition
|
|
Term
| What are strategies for the management of IUGR? |
|
Definition
| adequate dehydration, diet rich in protein and iron, conservation of energy, and decreasing workload responsibilities |
|
|
Term
| What ethnic groups are most at risk for macrosommia? |
|
Definition
| AA, Asian American, and Latin American |
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|
Term
| Polyhydramnios is often benign but if it is severe hydramnios is often associated with |
|
Definition
| CNS abnormaliteis, hydrops, and diabetes for example |
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Term
| Oligo is most often associated with |
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Definition
|
|
Term
| decreased or absent fluid causes |
|
Definition
| limb contractures, compressed face, hypoplastic lungs, renal agenesis, and potters syndrome with bilateral renal agenesis |
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|
Term
| Age is a single risk factor for |
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Definition
|
|
Term
| ______ contributes to folate deficeincy |
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Definition
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