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Questions and Answers
What primarily causes insulin resistance during pregnancy?
At what stage of pregnancy is screening for gestational diabetes typically performed?
Which hormone primarily ensures glucose availability for the developing fetus by reducing insulin effectiveness?
What is a common sign indicating gestational diabetes?
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What effect does growth hormone have during pregnancy in relation to insulin?
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What happens to insulin resistance as the placenta grows during pregnancy?
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Which of the following describes the 1-hour glucose challenge test used for GDM screening?
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Which of the following hormones raises blood sugar levels by stimulating cortisol production during pregnancy?
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What fasting plasma glucose level is considered diagnostic for gestational diabetes mellitus (GDM)?
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What is the main reason for conducting a 3-hour glucose tolerance test in pregnant individuals?
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Which of the following plasma glucose levels at 1 hour after a glucose load indicates a diagnosis of GDM?
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What is the impact of insulin administration on the fetus during gestational diabetes management?
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What is a potential complication of uncontrolled gestational diabetes for the fetus?
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When is a Cesarean section recommended for a pregnant person with gestational diabetes?
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What fetal condition can result from hyperinsulinemia due to gestational diabetes?
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Which maternal condition is associated with gestational diabetes and can have serious consequences?
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Which of the following is NOT a risk of gestational diabetes for the birthing person?
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What complication may arise due to macrosomia in infants of mothers with gestational diabetes?
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Which of the following describes a condition where the fetus may be smaller than normal due to gestational diabetes?
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Which of the following scenarios can lead to stillbirth in poorly controlled maternal diabetes?
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Which of the following treatments for gestational diabetes firstly aims to control blood sugar levels without medication?
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Study Notes
Gestational Diabetes (GDM)
- GDM develops during pregnancy due to insulin resistance caused by hormonal changes.
- Insulin resistance increases as pregnancy progresses, requiring more insulin to maintain normal blood sugar levels.
Diagnosis
- Pregnancy-related hormones, such as human placental lactogen, progesterone, growth hormone, and corticotropin-releasing hormone, act as insulin antagonists.
- Increased insulin resistance is evident, particularly in the second and third trimesters, due to placental growth and hormonal production.
Signs and Symptoms
- High blood glucose levels are the primary indicator of GDM, resulting from the body's inability to regulate sugar due to insulin resistance.
Screening Lab Evaluation
- Screening for GDM occurs at 24-28 weeks of pregnancy when insulin resistance is most pronounced.
- A 1-hour glucose challenge test involves consuming 50 gm of glucose; a significant blood sugar rise (≥ 135-140 mg/dl) suggests potential GDM.
- A 3-hour glucose tolerance test, after an 8-12 hour fast, confirms diagnosis if 2 or more blood sugar levels exceed set thresholds (e.g., fasting ≥ 95 mg/dl, 1-hour ≥ 180 mg/dl).
Management in Pregnancy
- Many cases of GDM can be managed through dietary modifications to control blood sugar levels.
- Oral hypoglycemics must be used cautiously, as some can cross the placenta and affect fetal development.
- Insulin therapy is preferred since it does not cross the placenta, minimizing risks to the fetus.
- Fetal weight should be monitored as GDM can lead to macrosomia, increasing delivery complications.
Birth and Timing Considerations
- C-section may be considered for infants estimated to weigh over 4,500 gm (~9.9 lbs) to prevent birth injuries.
Risks to the Fetus
- Macrosomia occurs due to fetal hyperinsulinemia, leading to higher risks of birth injury during delivery.
- Hypocalcemia and hypomagnesemia can arise from metabolic changes in diabetic pregnancies.
- Intrauterine Growth Restriction (IUGR) can result from maternal vasculopathy, limiting fetal growth.
- Other risks include asphyxia related to metabolic disturbances, respiratory distress syndrome, polycythemia, hyperbilirubinemia, and prematurity.
- There’s an increased risk of cardiomyopathy and stillbirth in poorly controlled diabetes, particularly after 36 weeks.
Risks to the Pregnant/Birthing Person
- Hypoglycemia may occur from insulin or medication adjustments alongside dietary changes.
- Those with GDM face an increased risk of preeclampsia, a condition causing high blood pressure and organ issues.
- Cesarean delivery is more likely due to complications from macrosomia.
- A history of GDM raises the risk of developing Type 2 diabetes later in life due to ongoing insulin resistance.
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Description
This quiz covers the essential aspects of Gestational Diabetes Mellitus (GDM), including its development, diagnosis, and symptoms during pregnancy. Understand the hormonal changes that contribute to insulin resistance and the importance of proper screening. Test your knowledge of how GDM affects both the mother and developing fetus.
