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Questions and Answers
What is the percentage decrease in neonatal hospital stay associated with breastfeeding in mothers on methadone or buprenorphine?
What is the recommended course of action for a breastfeeding mother who is unable to quit smoking?
What is the effect of one drink a day or more on milk production in breastfeeding mothers?
What is the current recommendation for breastfeeding mothers who use marijuana?
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How long should a breastfeeding mother who uses meth wait before resuming breastfeeding after recreational use?
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What is the effect of 'pumping and dumping' breastmilk on the level of alcohol in breastmilk?
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What is the primary reason for referring women to an Ob provider around 10-12 weeks of pregnancy?
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Which of the following maternal conditions is NOT commonly associated with increased pregnancy complications?
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What significant physiologic change occurs in pregnant women affecting carbohydrate metabolism?
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During which weeks of gestation is screening for gestational diabetes typically performed?
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Why might the A1C test be less accurate during pregnancy?
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What is the initial step in the standard oral glucose challenge test for diagnosing gestational diabetes?
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What is the significance of understanding the early pregnancy period from 0 to 8 weeks?
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What is the potential risk for diabetic patients during pregnancy due to alterations in metabolism?
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What is the most common cause of fetal macrosomia?
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When should gestational diabetes typically be assessed during pregnancy?
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What is the recommended action for patients with gestational diabetes who have an estimated fetal weight over 4500 grams?
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Which medication is considered first line for treating diabetes in pregnancy?
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What is the advised fasting blood glucose target for pregnant women to prevent complications?
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What role does low-dose aspirin play in pregnancy?
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What is considered a normal parameter for blood pressure in a pregnant woman, requiring intervention if exceeded?
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What dietary recommendation is made for pregnant women with diabetes regarding carbohydrate intake?
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After delivery, when should women be screened for diabetes if they had gestational diabetes during pregnancy?
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What is the primary benefit of opioid agonist therapy such as methadone for pregnant women with opioid use disorder?
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Study Notes
High-Risk Pregnancy Overview
- Referral to obstetric provider typically occurs between 10-12 weeks of pregnancy.
- Aim is to ensure patients' pre-pregnancy health to reduce complications during pregnancy.
Risk Factors for Maternal Outcomes
- Preexisting health conditions increase pregnancy complication risks and disease progression.
- Common conditions impacting pregnancy include anemia, cancer, diabetes, gastrointestinal disorders, heart disease, hypertension, infections, kidney disease, obesity, and thyroid disorders.
Pregnancy and Diabetes
- Diabetes prevalence is rising.
- Organ development occurs mainly during the first 8 weeks of pregnancy.
- Diabetes can significantly increase the risk of pregnancy complications.
- Hormonal changes lead to altered carbohydrate metabolism, often resulting in insulin resistance requiring tighter blood sugar control for diabetic patients.
Gestational Diabetes Diagnosis
- Screening recommended between 24-28 weeks gestation using the glucose tolerance test.
- A1C tests may be less reliable during pregnancy due to increased red blood cell counts.
- Standard practice includes using a 50-gram oral glucose challenge to assess insulin response.
- Excess sugar can cross the placenta, causing increased fat storage in the fetus, but the risk of fetal malformations is lower after the first trimester.
Pre-gestational Diabetes Risks
- Associated with miscarriage, stillbirth, congenital anomalies, growth issues, and worsening diabetes complications.
Gestational Diabetes Complications
- Develops around 24-28 weeks and poses risks for developing diabetes later, macrosomia, polyhydramnios, and stillbirth.
Fetal Macrosomia
- Large infants may require NICU care due to difficulty regulating their blood sugar.
- Increased risk of childhood obesity.
Preconception Care for Diabetes
- Discuss pregnancy plans during routine visits.
- Recommend prenatal vitamins (400 mg folic acid, 150 µg potassium iodide).
- Optimal glycemic control and careful medication review necessary before conception.
- Taking prenatal vitamins three months before conception improves outcomes.
Management in Pregnancy
- Aspirin recommended for women at risk for pre-eclampsia.
- Routine fetal anatomy ultrasounds and serial growth assessments are important.
- Delivery timing should consider glucose control and fetal weight.
Postpartum Care
- Encourage breastfeeding and provide contraception counseling.
- Screen for diabetes postpartum at six weeks.
Hypertensive Disorders of Pregnancy
- Chronic hypertension present before 20 weeks is a significant concern, alongside gestational hypertension, preeclampsia, and eclampsia.
- Management involves preconception care, medication options (Nifedipine, Labetalol), and monitoring blood pressure thresholds (≥140/90 mmHg).
Aspirin in Hypertension
- Low-dose aspirin (162 mg daily) recommended between 12-28 weeks to improve uteroplacental blood flow and reduce adverse outcomes.
Preterm Birth
- Defined as delivery before 37 weeks; associated with increased morbidity and mortality risks.
- Risk factors include uterine contractions, cervical insufficiency, and other medical indications.
Prevention of Preterm Birth
- Assess risk through thorough OB/GYN history and modify risk factors.
- Progesterone can be administered vaginally to help reduce risks.
- Importance of minimizing environmental stressors for both infant and mother.
Treatment of Substance Use Disorders
- Behavioral counseling and individualized prenatal care are essential.
- Avoid abstinence for opioid use disorders due to relapse risks; rather, utilize methadone or buprenorphine.
Benefits of Opioid Agonist Therapy
- Significantly reduces maternal overdose deaths, HIV risks, and stabilizes maternal opioid levels, benefiting fetal well-being.
Breastfeeding and Opioid Use
- Breastfeeding is encouraged even for mothers on methadone or buprenorphine.
- It decreases Neonatal Opioid Withdrawal Syndrome (NOWS) and hospital stays.
Breastfeeding Considerations
- Alcohol consumption can decrease milk production; abstinence is safest.
- Smoking cessation is recommended, but breastfeeding is better than no breastfeeding if cessation fails.
- Limited data on marijuana suggests abstinence; THC can negatively affect development.
- Meth and cocaine usage is strongly discouraged during breastfeeding due to potential harm.
Dietary and Exercise Recommendations
- Suggested 150 minutes of exercise weekly; balanced caloric distribution is important for maternal and fetal health.
- Specific macronutrient guidelines: 40-50% complex carbohydrates, 20% protein, and 30-40% unsaturated fats.
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Description
Learn about the timely referral of women to OB providers, ensuring a safe pregnancy, and risk factors for maternal outcomes due to preexisting health conditions.
