questions 2

Gestational Diabetes

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Topic updated on 09/24/16 11:37am

Introduction
  • Onset of insulin resistance during pregnancy
    • mediated by placental release of human placental lactogen (HPL), cortisol, and progesterone
  • Pathophysiology of hyperglycemia/insulinemia on the fetus
    • macrosomia
      • adiposity
      • insulin functions as a growth hormone
    • respiratory distress syndrome
      • insulin decreases production of surfactant
    • post-partum neonatal hypoglycemia  
      • high insulin levels in absence of high maternal glucose results in rapid drop in newborn blood glucose
Evaluation
  • Gestational diabetes screen 
    • between 24-28 weeks gestation
    • postive test if > 140 mg/dL 1 hour post-glucose challenge
    • follow up with confirmatory 3 hour glucose challenge
Treatment
  • Pharmacologic 
    • insulin in mothers with poor glycemic control
Prognosis, Prevention, and Complications
  • ↑ risk of GDM in future pregnancies, as well as type II diabetes
  • ↑ risk of neural tube defects, macrosomia, caudal regression syndrome in infant


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Qbank (2 Questions)

TAG
(M1.EC.14) A 27-year-old woman gives birth to a boy at 36 weeks gestational age. The infant weighs 4022 grams at birth, is noted to have a malformed sacrum, and appears to be in respiratory distress. Apgar scores are 5 and 7 at 1 minute and 5 minutes respectively. Hours after birth, the infant is found to be irritable, bradycardic, cyanotic, and hypotonic, and the infant's serum is sent to the laboratory for evaluation. Which of the following abnormalities would you expect to observe in this infant? Topic Review Topic

1. Hypoinsulinemia
2. Hyperglycemia
3. Hypoglycemia
4. Hypercalcemia
5. Hypermagnesemia

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TAG
(M1.EC.45) A newborn whose mother had uncontrolled diabetes mellitus during pregnancy is likely to have which of the following findings? Topic Review Topic

1. Atrophy of pancreatic islets cells
2. Hypoglycemia
3. Hyperglycemia
4. Amyloid deposits in pancreatic islets
5. Ketoacidosis

PREFERRED RESPONSE ▶


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