Diabetes Mellitus Incidence and Classification

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Questions and Answers

What percentage of diabetes in pregnant women is gestational?

90-100%

60-70%

70-80%

80-90% (correct)

What is the primary factor associated with progressive insulin resistance during pregnancy?

Increasing levels of estrogen and progesterone

Rising levels of human placental lactogen (correct)

Decreasing levels of insulin-like growth factor

Decreasing levels of prolactin and cortisol

What is pregestational diabetes mellitus?

Diabetes that develops after pregnancy

Diabetes present before pregnancy (correct)

Diabetes that develops during pregnancy

Diabetes that occurs during childbirth

What is the purpose of the White classification of diabetes during pregnancy?

To assess disease severity and the likelihood of complications Signup and view all the answers

What is the consequence of maternal hyperglycemia on the fetus?

Fetal hyperglycemia Signup and view all the answers

What is the term used to describe the group of risk factors for diabetes, coronary heart disease, and stroke that occur together?

Metabolic syndrome Signup and view all the answers

What is the result of fetal hyperglycemia during the period of embryogenesis?

Teratogenic effects Signup and view all the answers

What is the percentage of diabetes in the United States?

6-12% Signup and view all the answers

What is the direct correlation with birth defects in diabetic pregnancies?

Increasing glycosylated hemoglobin A1C (HbA1C) levels in the first trimester Signup and view all the answers

What is the primary cause of fetal demise in diabetic pregnancies?

All of the above Signup and view all the answers

What is a common maternal complication associated with pregestational diabetes?

Worsening nephropathy Signup and view all the answers

What is the timing of universal screening for gestational diabetes according to the American College of Obstetricians and Gynecologists (ACOG)?

Between 24 and 28 weeks' gestation Signup and view all the answers

What is the primary purpose of the 50-g, 1-hour oral glucose challenge test (OGCT) in gestational diabetes screening?

To identify most women with gestational diabetes while allowing for several weeks of therapy Signup and view all the answers

Which of the following is a risk factor for gestational diabetes?

All of the above Signup and view all the answers

What is a common fetal complication associated with pregestational diabetes?

All of the above Signup and view all the answers

Why is hypoglycemia more common in women with pregestational diabetes?

Due to the need for insulin therapy and stricter glycemic control Signup and view all the answers

Study Notes

Incidence and Classification of Diabetes Mellitus

The prevalence of diabetes mellitus has increased significantly over the last 20 years.
In the United States, the rates of diabetes range from 6-12% depending on the population and diagnostic criteria.
80-90% of diabetes in pregnant women is gestational, and 10% is pregestational.
Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy.
Rising levels of human placental lactogen, progesterone, prolactin, and cortisol in pregnancy contribute to progressive insulin resistance.
Women who develop GDM have chronic insulin resistance, and GDM is a "stress test" for the development of diabetes later in life.

Classification of Diabetes During Pregnancy

Pregestational diabetes mellitus refers to diabetes present before pregnancy and may be either type 1 or type 2 diabetes.
The White classification is used to further refine the categories for GDM and pregestational diabetes.
This classification is helpful for assessing disease severity and the likelihood of complications.

Complications of Diabetes

Maternal and fetal complications of diabetes include risks associated with the metabolic syndrome (central obesity, insulin resistance, and hyperlipidemia).
Most fetal and neonatal effects are attributed to maternal hyperglycemia or maternal vascular disease.
Glucose crosses the placenta easily, causing fetal hyperglycemia, which stimulates pancreatic β-cells and results in fetal hyperinsulinism.
Fetal hyperglycemia during embryogenesis is teratogenic and correlates with birth defects and increasing glycosylated hemoglobin A1C (HbA1C) levels in the first trimester.

Fetal Complications

Fetal hyperglycemia and hyperinsulinemia later in pregnancy cause fetal overgrowth and macrosomia, predisposing to birth trauma, including shoulder dystocia and Erb palsy.
Fetal demise is due to acidosis, hypotension from osmotic diuresis, or hypoxia from increased metabolism, coupled with inadequate placental oxygen transfer.

Pregestational Diabetes

Pregestational diabetes is associated with a higher rate of maternal and fetal complications due to difficulty in achieving glycemic control, higher rates of congenital malformations, and vascular disease.
Maternal complications include worsening nephropathy and retinopathy, preterm preeclampsia, and a higher likelihood of diabetic ketoacidosis.
Fetal complications include an increased rate of abortions, anatomic birth defects, fetal growth restriction, and prematurity.

Diagnosis of Gestational Diabetes Mellitus

The American College of Obstetricians and Gynecologists (ACOG) recommends a two-step method to test for GDM.
The first step involves universal screening for gestational diabetes between 24 and 28 weeks' gestation with a 50-g, 1-hour oral glucose challenge test (OGCT).
Screening is advised at the first prenatal visit in women with risk factors such as a previous pregnancy with GDM, history of polycystic ovarian disease, or obesity.

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Description

Learn about the increasing prevalence of diabetes mellitus, its classification, and types, including gestational diabetes mellitus (GDM) and pregestational diabetes.