Endocrine: Gestational DM

Serotonin production in beta-cells increased

beta-cell expansion

beta-cell glucose sensitivity increases

Insulin secretory capacity increases

• No changes in alpha-cell mass or glucagon
• secretion

-> increased insulin resistance

• Decreases as gestation progresses
• -> increased insulin resistance

• Pre-eclampsia
• Birthing large for gestational age (LGA) babies

• Macrosomia
• LGA birth

Fasting 100g OGTT

Fasting 50g oral glucose challenge test

if >/= 130-140 -> Fasting 100g OGTT

• AA
• Asian
• Hispanic
• NA
• PI

• Low risk ethnic group
• < 25 yo
• No 1st ^o relative w/DM
• Pre-pregnancy BMI < 25
• Normal birth weight
• No Hx of poor obstetric outcomes
• No Hx of poor glucose metabolism

(No test)

• Severely obese
• FH of T2DM
• Hx of GDM

(test STAT)

(test @ 24-28 weeks)

• Insulin
• Glyburide (stop 2wks pre-delivery)
• Metformin

• NPH QHS
• AM dose held -> normal saline infusion

change to D5W @ <70 or active labor

1.25 U/h @ >100 (adj. PRN)

Hourly finger sticks

Occurs @ birth d/t 2nd/3rd trimester poor glucose control

• Hypokalemia
• Hypocalcemia
• Hypomagnesemia
• Hypoglycemia (<25-40 mg/dL)

• Inc. O2 demand d/t inc. catabolism
• Increased red cell production
• Hyperbilirubinemia (Inc. red cell turnover)

D10W 1-2 mL/kg