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Why is glycemic control important before and during pregnancy?
- High glucose or glycohemoglobin levels during embryogenesis are associated with high rates of spontaneous abortions and major malformations in newborns
- Increased risk for the mother to develop hypoglycemia, retinopathy, HTN, nephropathy, and CAD
- To avoid hypoglycemia in the baby at birth
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What 2 counseling points are essential for wmoen with DM of child-bearing potential?
- The risk of malformations associated wtih unplanned pregnancies and poor metabolic control
- Use of effective contraception unless at good control and actively trying to conceive
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What medications associated with diabetes should be discontinued prior to conception?
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What are the preconception goals for glycemic control?
- Fasting: 80-110
- PPG: < 155 at 2h
- A1c: < 5%
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At what A1c do complications start?
6%
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What complications of DM need consideration before pregnancy?
- Hypglycemia (increased risk to the mother)
- Retinopathy (increased rate of development)
- HTN (pre-existing or pregnancy induced)
- Nephropathy (may become permanent)
- Neuropathy (can be exaerbated and complicate DM management)
- CAD (increased risk of mortality during pg)
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What is GDM?
gestational diabetes mellitus = any degree of glucose intolerance with onset or first recognition during pg whether insulin or diet modification is used for control and whether or not it persists after pg
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What factors place a woman at high risk of developing GDM?
- Marked obesity
- Personal hx of GDM
- Glycosuria
- Strong family hx of diabetes
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When should women at average or high risk with a negative initial screening undergo testing for GDM?
24-48 weeks of gestation
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When should women at low risk of GDM be tested?
they don't require testing
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Who are women at low risk for GDM?
- < 25yo
- Normal wt before pg
- White
- No 1st degree relatives with DM
- No hx of abnormal glucose tolerance
- No hx of poor obstetric outcome
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What is a one-step glucose tolerance test?
- OGTT (oral glucose tolerance test):
- 100g oral glucose load
- check BG at fasting, 1h, 2h, 3h
- Should be < 180, 155, or 140 respectively
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What is a Two-step glucose tolerance test?
- Initial screening 50g oral glucose load should be < 140 at 1h
- If not do an OGTT
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What are the 7 perinatal complications associated with GDM?
- Fetal macrosomia
- Neonatal hypoglycemia, jaundice, polycythemia, or hypocalcemia
- HTN
- C-section
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What are the long-term risks of GDM?
- Increased risk to develop DM in mother
- Increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood
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What are the glycemic goals during pregnancy?
- FBG < 105
- 1h PPG = 155 or less
- 2h PPG = 130 or less
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How often should glycemic status be checked post-partum if glucose levels were normal?
at least every 3yrs
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How often should glycemic status be checked post-partum if patient was IFG or IGT?
annually
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What medications should be avoided in pts with a hx of GDM to prevent development of glucose intolerance/DM?
- Glucocorticoids
- Nicotinic acid
- High-dose Niacin
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How should GDM be treated?
- If BMI > 30, reduce caloric intake by 30-33%
- Decrease Cargs to 35-40% of caloric intake
- Human insulin only
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