Prevalence and Risks
Some risks associated with Gestational Diabetes to the mother
What are preeclampsia (9.8%>18%), Cesarean Delivery( 9.5%>17%>25%)
The optimal 1 hour and 2hr post prandial values according to the GDM Practice Bulletin
What is 140 and 120?
True/False: It is appropriate to continue this metformin if a patient was on it prior to pregnancy for PCOS
True
What glucose monitoring measure is predictive of increased neonatal fat mass?
What is fasting BG
Appropriate first line therapy for GDM
What is insulin (preferred) or metformin
NOT glyburide
-evidence indicates that glyburide treatment should not be recommended as a first-choice pharmacologic treatment because, in most studies, it does not yield equivalent outcomes to insulin or metformin.
The percentage of pregnancies complicated by diabetes (either gestational or pregestational)
What is 7%
Approximately 86% of these are GDM
BMI at which early screening is indicated
What is 40?
OR BMI 25 with at least one other risk factors: 1 deg family or personal history of diabetes, HTN, cardiovascular disease, high cholesterol, PCOS, high risk ethnicity, previous birth >4000g, etc
Early screening can be done with 2hr 75g GTT, two-step test, or A1C
Optimal percentage of daily carbohydrate intake
What is 33-40%?
True/False: Metformin does not cross the placenta
What is false
Percentage of women who will develop diabetes later in life if they had GDM
What is up to 70% (within 22-28 years)
Bonus: 60% of latina patients will develop DM within 5 years from index pregnancy
What are the cut-offs for 3-hr GTT? (fasting, 1hr, 2hr, 3hr)
What is 95, 180, 155, 140
(based on Carpenter and Coustan criteria vs National Diabetes Data Group)
How and when to test for GDM postpartum
What is 2-hr GTT 4-12 weeks postpartum
What EFW is reasonable to offer CS for GDM?
What is 4500g
Ethnic groups with a prevalence for GDM (5)
What are Hispanic, African American, Native-American, Asian, Pacific-Islander women?
When to repeat screen for diabetes if postpartum testing is normal?
The ADA and ACOG recommend repeat testing every 1–3 years for women who had a pregnancy affected by GDM and normal postpartum screening test results.
Weight-based dose for starting insulin? (units/kg daily)
What is typical starting total dosage is 0.7–1.0 units/kg daily. This dosage should be divided with a regimen of multiple injections using long-acting or intermediate-acting insulin in combination with short-acting insulin.
MOA of metformin (3)
What are inhibit hepatic gluconeogenesis, inhibits hepatic glucose absorption, stimulates glucose uptake in peripheral tissues?