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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 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 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 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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
What is the most common cause of fetal macrosomia?
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When should gestational diabetes typically be assessed during pregnancy?
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?
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?
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?
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?
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?
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?
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?
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?
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.
