Diabetes during Pregnancy Flashcards

Diabetes Types during Pregnancy

• Diabetes is categorized as either pregestational (diagnosed before pregnancy) or gestational diabetes mellitus (GDM, diagnosed during pregnancy).
• Pregestational diabetes includes patients with type 1 and type 2 diabetes prior to becoming pregnant.
• GDM is characterized by carbohydrate intolerance that appears during pregnancy, with potential undiagnosed pregestational diabetes included in this group.

True Gestational Diabetes Mellitus

• GDM is a temporary impairment in carbohydrate metabolism that emerges during pregnancy.
• Pregnant women may exhibit baseline carbohydrate metabolism issues or may be normal beforehand.
• Pregnancy hormones, such as human chorionic somatomammotropin, increase insulin resistance and carbohydrate intolerance.

Insulin Balance during Pregnancy

• A balance between insulin production and sensitivity is crucial; thus, beta cell function in the pancreas may be influenced.
• Beta cell hypertrophy occurs in early pregnancy, allowing increased insulin production to combat insulin resistance caused by placental hormones.

Timing and Risks of GDM

• Carbohydrate metabolism abnormalities typically do not manifest until late second or early third trimester, differentiating GDM from pregestational diabetes.
• GDM pregnancies are less likely to result in congenital anomalies but are associated with risks for fetal macrosomia, birth injuries, and neonatal complications.
• Women with GDM have a 4 to 10-fold lifetime risk of developing type 2 diabetes mellitus.

Demographics and Risk Factors

• Higher rates of GDM are observed in women of Hispanic/Latina, Asian/Pacific Islander, and Native American descent.
• Risk factors include:
  • Increasing maternal age
  • Obesity
  • Family diabetes history
  • Previous infants over 4,000 grams
  • History of stillbirth

Screening Recommendations

• Optimal screening time for low-risk women is at 24 to 28 weeks' gestation.
• Women with risk factors for GDM should be screened at their first prenatal visit.
• If initial screening for diabetes is negative, further GDM screening occurs in the early third trimester.

Laboratory Testing Procedures

• Common initial screening involves a 50-g glucose load, followed by measuring plasma glucose after 1 hour.
• A glucose level exceeding 130 or 140 mg/dL prompts a glucose tolerance test (GTT) with a 100-g glucose load.
• GTT involves fasting overnight then measuring glucose levels at fasting, 1 hour, 2 hours, and 3 hours post-glucose load, diagnosing GDM if two or more values are elevated.

Alternative Screening Method

• An alternative screening could involve a fasting blood glucose test, followed by a 75-g load with 1-hour and 2-hour glucose assessments.
• A single elevated value among the three tests would indicate GDM.

Management Post-Diagnosis

• Upon diagnosing GDM, patients are generally placed on a diabetes-specific diet.
• The American Diabetes Association recommends a 2,200-calorie daily diet during pregnancy, emphasizing the importance of total carbohydrate intake.