HTN and Gestational Diabetes in Pregnancy PDF
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Uploaded by NicerNovaculite6814
Barry University
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Summary
This document covers hypertension and gestational diabetes during pregnancy. It details the causes, management, and potential complications of these conditions. It also includes information on risk factors, testing, and treatment options, including the importance of early detection and proper care.
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2. HTN and Gestational Diabetes in Pregnancy Hypertension in Pregnancy o Transient HTN â–ª HTN occurring in late preg w/o other features of preeclampsia & w/ normalization of BP postpartum (PP) â–ª Patho is unknown- may be forerunner of chronic HTN later...
2. HTN and Gestational Diabetes in Pregnancy Hypertension in Pregnancy o Transient HTN â–ª HTN occurring in late preg w/o other features of preeclampsia & w/ normalization of BP postpartum (PP) â–ª Patho is unknown- may be forerunner of chronic HTN later o Chronic HTN â–ª BP >140 mm Hg systolic &/or 90 mmHg diastolic â–ª Before pregnancy or before 20 wks of gestation or use of antihypertensive med before pregnancy or persistence for >12 wks after delivery â–ª Management: goal to reduce risk of CV and cerebrovascular events 2 criteria o Mild: SBP 140-159, DBP 90-109 o Severe: SBP >160, DBP 160 or Diastolic >110 Major risk- development of preeclampsia or eclampsia later on o Pregnancy Induced Hypertension (PIH) â–ª Aka gestational HTN â–ª 2nd half of preg after 20 wks â–ª *No proteinuria â–ª Develops in 5-10% preg, 30% multiple gestations, 50% progress to pre/eclampsia â–ª Causes 20% of maternal deaths, Associated w/ ^ perinatal M&M for mother and fetus o Pre-eclampsia â–ª new onset HTN w/ *proteinuria after 20 weeks gestation â–ª Mild: SBP >140, DBP >90, and proteinuria 300 mg in 24 hr urine â–ª Severe: SBP >160 or DBP > 110 and > 5 g protein in 24 hr urine â–ª Risk factors: nulliparous, >35 yrs, FMH of eclampsia, pre-existing HTN, renal disease, multiple gestation, pre-gestational DM, obesity â–ª S&S: HA, visual disturbances (blurred vision or spots-scotomata), weight gain, edema (esp. In hands or face), elevated BP, proteinuria â–ª Management of mild: prior to 37 wks: expectant management, frequent maternal & fetal evaluation, rest, monitor, testing for fetal growth restriction twice weekly, assess amniotic fluid every 3 weeks At or beyond 37 weeks: induce labor or C-section â–ª Management of severe: *MgSO4: loading dose followed by maintenance, monitor therapeutic level Titrate hydralazine to acceptable BP *Delivery is ultimate Rx o at or beyond 34 wks, induce labor or C section o Before 34 weeks, hospital admission w/ expectant management if mother is stable and fetal condition is reassuring â–ª Give corticosteroids for fetal lung maturity prior to delivery â–ª HELLP syndrome Preeclampsia with: o Hemolysis, Elevate Liver enzymes, Low Platelet count Life threatening condition, occurs w/ severe preeclampsia or eclampsia Usually occurs before the 37th weeks of preg but can occur shortly after delivery S&S: HA, worsening N/V, RUQ pain/tenderness, fatigue, malaise, visual disturbances (usually subsides w/in 2-3 days of delivery) Rx: delivery is best therapy o >34 wks delivery, natural or Caesarian o 50% â–ª Glucose tolerance screening 2-4 mths post-partum (60-90% recurrence in subsequent pregnancies) o Child 8X more likely to develop T2DM & obesity in teens or early adulthood Clinical features Usually asymptomatic Risk factors Obesity (BMI >25) Personal or FH of DM, previous GDM Advanced maternal age, non-white ethnicity *Patho Insulin resistance occurs during preg due to placental secretion of hormones Cause postprandial (after eating) hyperglycemia & carbohydrate intolerance, allows fetus to consume more nutrients Can cause lower fasting blood glucose level, pancreas can compensate here GDM develops when pancreas cannot compensate for insulin resistance o Due to Beta cell deficits o Might have subclinical metabolic dysfunction prior to conception Testing Risk factors & undiagnosed DM at 1st prenatal visit (do urine, not blood) *Women w/o DM: at 24-28 wks Women w/ GDM: 4-12 wks postpartum Women w/ H/O GDM: lifelong screening for pre/diabetics at least every 3 years Lab studies Screen at 24-28 weeks 50-g 1 hour oral glucose challenge. Draw blood after 3 hours: *If > or equal to 130 mg/dL requires 3-hour GTT Requires 100-g loading dose, Dx is pos if 2 of 3-hr values are increased Screen high risk patients earlier Dx GDM requires at least 2 of these values o *Fasting >95 mg/dL, 1 hr: >180 mg/dL, 2 hr: >155 mg/dL, 3 hr: >140mg/dL Rx Lifestyle modifications, best: diet and exercise Insulin- first line therapy Frequent blood sugar monitoring (4x daily), daily injections or continuous sc infusions Goal: *FBS
