Diabetes Mellitus
True or False: not all pregnant women need to be screened
FALSE !
ALL pregnant women should be screened
What do we want to prevent when it comes to cardiac diseases?
True or False: anemia is one of the most common pregnancy problems worldwide
TRUE
Which autoimmune disorder is associated w/ increased risk of miscarriage and fetal death in the 1st trimester?
lupus
True or False: you can give pregnant women the rubella vaccine, but not varicella
FALSE !
live vaccines CANNOT be given during pregnancy
Name the types of diabetes and describe them
(Hint: think abut insulin dependency and when they are diagnosed)
Type 1: insulin dependent, onset in childhood/early adulthood
Type 2: can be diet controlled or require insulin, onset usually after age 40
Gestational: can be diet controlled or insulin w/ diet controlled, first diagnosed during pregnancy
What is the primary goal for management of cardiac disease?
prevent development of CHF
True or False: you can meet iron needs from diet alone if you have iron deficiency anemia
FALSE ! it is difficult to meet iron needs from diet alone
Ferrous sulfate is prescribed as a supplement in addition to prenatal vitamins
Which autoimmune disease causes most cases of hypothyroidism?
Hashimoto's thyroiditis
Mothers with HIV will have a low/high viral load, which results in the fetus viral load to be low/high
When should a Glucose Challenge and a Glucose Tolerance Test be performed?
What are the abnormal glucose levels at 1 hour and 3 hours for the GTT?
Glucose Challenge is performed b/w 24-28 weeks of gestation
GTT is performed when woman is high risk or if GCT is elevated
1 hour is >180 mg/dL
3 hours is > 140 mg/dL
What is a shunt?
What is the difference between left-to-right shunt and right-to-left shunt?
A cardiac shunt is when blood is not flowing normally through the heart
Left-to-right is not related to cyanosis
Right-to-left is usually cyanotic
What is folic acid deficiency associated with?
Neural tube defects
(also miscarriage and abruption)
What is the primary goal of seizures management?
Which meds should be avoided?
PREVENTION
Valproic acid and divalproex acid
What is the leading cause of life threatening infections in new borns?
Group B streptococcus
Risk factors for Gestational DM
- overweight or obese (BMI > 25)
- maternal age 25+
- GDM in previous pregnancy
- hx of abnormal glucose tolerance level, or diabetes in close relatives
- member of high risk ethnic group
What disease is a complication of strep throat?
What valve is a common site of stenosis and scarring?
Rheumatic heart disease
Mitral valve is the most common site of stenosis and scarring
Thalassemia is a genetic disorder of ...
What lab value is advised for pregnancy? (Hint: lab values are similar to iron deficiency)
abnormal synthesis of hemoglobin (alpha and beta chains)
Hgb level of 10 g/dL
Which autoimmune disease is associated with increased risk for thrombosis, fetal loss, and low platelets?
What meds are recommended?
Antiphospholipid syndrome
Low dose aspirin and Enoxaparin
Which viral infections pose the greatest risk for harming the fetus?
(Hint: think TORCH)
Cytomegalovirus
Rubella
Varicella-zoster (chickenpox)
Parvovirus B19
Hepatitis B
What are the most common congenital malformations associated with preexisting diabetes?
Name maternal, fetal, and neonatal effects
Neural tube defects and Cardiac defects
Maternal: preeclampsia, UTIs, ketoacidosis, dystocia (large fetal size)
Fetal: neural tube defects, fetal cardiac defects, variations in fetal size (macrosomia)
Neonatal: hypoglycemia, hypocalcemia, hyperbilirubineemia, respiratory distress syndrome
What is the difference between Class I and II vs Class III and IV heart disease?
(include therapeutic management)
Class I and II are easier to manage
- limit physical activity, avoid excess weight gain, restrict Na, prevent/treat anemia and infection
Class III and IV require intensive management
- bed rest and prophylactic anticoagulant therapy
What is affected by Sickle Cell disease?
What can happen if sickle cell crisis occludes vessels in the placenta?
What is the best way to manage sickle cell crisis?
abnormal hub results in distortion and destruction of erythrocytes
the fetus can die
prevention is key!!!
- good hydration and nutrition, rest periods, folic acid supplements, good hygiene, avoidance of people with illness
What type of seizures are most commonly seen in epilepsy?
What can result in the fetus?
Generalized seizures
May result in fetal hypoxia and acidosis
True or False: GBS is ONLY a danger to the baby
What is the baby at risk for?
TRUE; mother is not in danger
Baby is at risk for GBS sepsis, pneumonia, and meningitis