Screening
What is considered a failed 1 hr GTT?
It depends on your institution!
No good evidence to suggest using one cut off value. Venous glucose draw value of 130, 135, or 140 one hour after 50g oral glucose load.
How much exercise is recommended for first line management of GDM?
30 minutes of moderate-intensity aerobic exercise at least 5 days a week or minimum 150 minutes per week
Fetal complications of GDM include?
Macrosomia, neonatal hypoglycemia, hyperbilirubinemia, stillbirth, polyhydramnios.
Who should get screened for pre-gestational diabetes or early GDM?
All women with BMI >25 + one additional risk factor
(Physical inactivity, 1st degree relative with DM, High-risk race or ethnicity (eg, African American, Latino, Native American, Asian American, Pacific Islander), Have previously given birth 9lber or more, Previous GDM, HTN (140/90 or on therapy for HTN), prior hx of HLD, PCOS, A1C >/= 5.7%, impaired glucose tolerance, or impaired fasting glucose on previous testing, other clinical conditions associated with insulin resistance (eg, prepregnancy BMI> 40 , acanthosis nigricans), History of cardiovascular disease)
What is the second line treatment for A2GDM?
Metformin (500 mg nightly for 1 week at initiation, then increases to 500 mg twice daily)
Women with fetus's measuring ______g should be counseled on delivery via c-section.
4,500 g
Metformin has been approved for the use of treating GDM by the FDA? True or False
FALSE
When should postpartum T2DM screening occur in women who were diagnosed with GDM?
Screening with the 75-g OGTT for type 2 diabetes during the delivery hospitalization in the immediate postpartum period is a reasonable alternative in lieu of performing the 75-g OGTT at 4–12 weeks postpartum and may increase the rate of postpartum testing
What is the starting dose of insulin therapy per 24 hrs?
0.7 to 1.0 units/kg daily
(Dosage should be divided and long-acting or intermediate-acting insulin in combination with short-acting insulin should be used)
Out of all pregnancies complicated by any type of diabetes (T1DM, T2DM, GDM), GDM is responsible for ___ % of cases.
86%
At what gestational age is fetal surveillance with BPP/NST initiated in patients with A2GDM?
32 weeks (There is no consensus regarding antepartum fetal testing among women with well-controlled GDM who are not medically treated)
When does postprandial glucose peak?
Postprandial glucose peaks at approximately 90 minutes.
So therefore glucose is recommended to be tested 4 times a day- Fasting and after each meal (can be 1 or 2 hr post-prandial)
What are the cut off values that ACOG recommends for the 3 hr GTT?
Carpenter and Coustan criteria:
What is the duration of action for NPH?
13-18 hr with peak at 5-7 hrs.
GDM increases the risk of what maternal complications?
Shoulder dystocia, birth trauma, c-section, pre-eclampsia.
When should A1GDM be delivered?
Controlled on diet: 39w0d to 40w6d
A2GDM (well controlled) delivery is recommended from 39 0/7 weeks to 39 6/7
What long term effects can be seen in children who were born to mothers diagnosed with GDM?
Fetal exposure to maternal diabetes contributes to childhood and adult-onset obesity and diabetes in offspring, which is independent of risks associated with obesity and genetic predisposition
What do you do if a patient technically passes their 3 hr GTT, but has one elevated value in the testing?
One value abnormal (impaired glucose tolerance): Women with a single abnormal value on the 3-hr OGTT have been reported to demonstrate insulin resistance similar to women with GDM and are more likely to deliver an LGA infant.
Therefore, proceed as follows:
1. Patient to check fasting and postprandial fingerstick (4 times daily) for 1-2 wks. If > 30% of BG values are abnormal = GDM.
2. If results are normal (<30% of BG values elevated), repeat 3 hr. OGTT in 4 weeks or continue checking BGs as above.
Metformin mechanism of action
Promotes gluconeogenesis and glucose absorption and stimulates glucose uptake in peripheral tissues
What % of women with GDM will develop DM outside of pregnancy?
Up to 70%
What is the earliest gestational age ACOG recommends delivery at for a poorly controlled A2GDM patient?
Overall recommendation is individualized, but delivery between 37w0d and 38w6d can be considered
*Delivery between 34w0d and 36w6d weeks 0 days reserved for (1) failure of in-hospital glycemic control or (2) abnormal fetal testing*
By what percentage do insulin requirements increase in the setting of pregnancy?
50-150%