Diabetes during Pregnancy Flashcards

Study Notes

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.

Description

This quiz covers essential concepts related to diabetes during pregnancy, focusing on pregestational and gestational diabetes. It is designed to help students understand the definitions and implications of diabetes in pregnant patients. Dive into the specifics of diabetes management and screening during this critical time.