Term
| What are the reproductive hormones? What do they all increase? |
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Definition
- HPL
- hCH
- Progesterone
- Estrogens
increase blood sugar
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Term
| What are the risk factors for gestational diabetes? |
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Definition
- advanced maternal age
- obesity
- family hx
- hx of baby >9lb
- AA, Hispanic, Asian, NA
- pregnancy loss
- previous birth w/ unidentified congenital anomaly
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Term
| What transfers to the fetus from mom? |
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Definition
- glucose!
- hyperglycemia is teratogenic
- mom has elevated ketones, fetus will too. so glucose & ketones will be elevated
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Term
| What does not transfer from mom to fetus? |
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Definition
- insulin. detected in fetus as early as 9GW
- glycogen
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Term
| What does the BS generally have to be for glucose to spill over into the urine? |
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Definition
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Term
What do you want the A1C to be?
What # do you multiply with to get the BS level? |
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Definition
- want <6. if >6.5 =greater risk for anomalies
- x25 to get blood glucose level!
- control over 8-12weeks
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Term
| According to the ACOG, when should you do universal screening for gestational diabetes? |
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Definition
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Term
Who are advocates for selective screening?
Who should you not screen? |
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Definition
- previous loss pregnancy, obese (screen before)
- do not screen ppl who already have diabetes
- should not fast, eat drink 1hr prior. Drink 5oz of glucola. blood drawn 1hr after. high risk will do early test
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Term
| What is ACOGs standard screening for 1hrGTT? |
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Definition
- 50g 1hr glucose
- >130 = abnormal
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Term
| What is the standard screening for the 3hr GTT? |
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Definition
- give 100g
- fastin > 95
- 1hr >180
- 2hr >155
- 3hr >140
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Term
| what can the fasting serum glucose and the random glucose be for it to be diagnostic of gest. diabetes? |
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Definition
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Term
| according to White classification, all below A require what? |
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Definition
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Term
| If the FBS > 90 (high), what will you have to do? |
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Definition
- put on insulin b/c diet is not controlling
- after several readings, use NPH hs
- 0.2u/kg
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Term
| What would you do if the postprandial (after meals) blood sugar is high? |
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Definition
- reg or lispro insulin - give ac (before meals)
- 1.5u/10gm CBO -before breakfast
- 1u/10gm CBO - before lunch & dinner
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Term
| If you are using NPH & regular insulin, how should you give? |
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Definition
- 45% NPH insulin (30% before brkfast, 15% bedtime)
- 55% preprandial regular insuline (22% brkfast, 16.5% lunch, 16.5% dinner
this is a way if person is not carb counting
**draw up regular 1st, NPH 2nd
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Term
| What do you do if you have a pre and post prandial high? |
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Definition
- 4 injections/day
- TOTAL DOSAGE =
- 0.7u/kg up to week 18
- 0.8u/kg weeks 18-26
- 0.9u/kg weeks 26-36
- 1.0u/kg 36weeks-term (more resistant)
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Term
| What do you do if the person cannot take insulin? |
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Definition
- glycoburide: 2.5-5mg bid
- Lantus: 5-10u (injections)
~normally do not use oral meds b/c teratogenic. but less risk w/ these to oral meds
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Term
| what is a way to dose insulin in the hospital if the pt is not normally taking insulin? |
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Definition
FBS - 100/(22)
subcut dose
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Term
| If someone is in acute hypoglycemia what should you give them? |
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Definition
- 10-20g of CBO
- *****1u of regular insulin will drop BS by 25mg/dl
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Term
| what insulin should you give during labor? |
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Definition
- usually fine w/o insulin
- Normal Saline - maintains normoglycemia 70-90. want <105
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Term
| What does bad gestational control mean? |
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Definition
- retarded lung development - decreased surfactant, RDS
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Term
If you have to do an early delivery, (preeclampsia), what should you do first?
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Definition
- amniocentesis - PG ratio and LS 2:1 - this checks the maturaity of the fetal lungs!
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Term
| What should you screen for post labor? |
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Definition
- development of type 2 diabetis
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Term
| What should you definitely do if you have type 1 diabetes before getting pregant? |
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Definition
- preconceptual counseling!!
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Term
| What are the 2 categories to place type 1 diabetics? |
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Definition
- Vascular disease present
- Vascular disease absent
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Term
| What tests should you do for type 1? |
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Definition
- A1C
- urinary proteinuria (nephrologist)
- TSH & T4 (thyroid problems)
- ECG (vascular dz, ischemic heart dz)
- dilated eye exam (kidney problems, retinopathy, send to an opthamalogist)
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Term
During the 1st trimester for type 1, what is important?
and esp for weeks 10-13?
and what is included in each trimester? |
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Definition
- ultrasound
- meds - if on ACE inhibitors or ARBs - take them off!!
- maintain BP - 110-129 S 65-79 D
10-13weeks
- A1C q 4-6 GW
- BS - home 4-8x/day
- urine ketones - illness BS>200
each tri:
- serum creatinine (.6-1) - renal function
- TSH & serum free T4 - baseline
- eye exam - baseline & q 3 mo
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Term
| What are the risk for type 1 diabetes? |
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Definition
- congenital anomalies
- Aneuploid testing - chromosome defect
- US - nucal translucency thickens is a risk for congenital heart defects
- pregnancy associated plasma protein A - (PAP A)
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Term
| How often should you see type 1 during the 2nd tri, and what is important to assess? |
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Definition
- seen q 2-4 GW
- Quad screen 15-18GW (AFP, urinary E3, hCG, inhibin A) (screening for NTD)
- US 18 GW - 4 chamber heart. CHD inc freq.
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Term
| How often should you see type 1 in the 3rd tri? What is imp to assess? |
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Definition
- seen q 1-2 weeks until 32 GW then weekly
- insulin resistance increases (need more insulin)
- NST @32 GW - if A1C >7 then do NST 2x/week
- US 28-30 GW - assess fetal growth
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Term
| Type 1 diabetics are at greater risk for what? |
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Definition
- preeclampsia (8%)
- HTN (17%)
- polyhydramnios (>1L of amniotic fluid)
- preterm labor
- PTD (22%)
- spontaneous PTD (16%)
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Term
| If the baby has an elevated BS even if it is full term what will be wrong? |
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Definition
- still have fetal lung immaturity
- compounds risk for RDS
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Term
| What should you give the mom if in preterm labor? |
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Definition
- give 2 betamethosone injections 12hr apart
- should increase the BS
- is a steroid
- begins 12hr after the first dose and will last up to 5 days
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Term
| What other drugs should you use for tocolytic therapy (anti-contractions) ? (other than betamethosone) |
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Definition
- Nifedipine - Ca channel blockers, reduce muscle contractility.
- MgSO4 - Ca channel blocker, most common
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Term
| For fetal lung maturation, what should you test if trying to deliver prior to 39GW? |
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Definition
- SPC (saturated phosphatidylcholine) in the amniotic fluid
- should be >1000mg/dL
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Term
| When would you deliver prior to 39GW? |
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Definition
- macrosomnic (<4500g)
- preeclampsia
- preterm labor
- fetal growth retardation
- abruptio placentai
- worsening of renal or retinal disease
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Term
| What are some fetal complications? |
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Definition
- directly r/t size of fetus and severity of diabetes
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