Term
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Definition
| Type 1 diabetes includes cases that are caused primarily by pancreatic islet beta cell destruction and that are prone to ketoacidosis. People with type 1 diabetes usually have an abrupt onset of illness at a young age and an absolute insulin deficiency. |
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Term
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Definition
| Is the most prevalent form and includes individuals who have insulin resistance and usually relative (rather than absolute) insulin deficiency. Causes are unknown at this time. It often goes undiagnosed for years because hyperglycemia develops gradually. |
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Term
| Gestational diabetes mellitus (GDM) |
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Definition
| any degree of glucose intolerance with the onset occurring during pregnancy. This definition is appropriate whether or not medication is used for treatment or the diabetes persists after pregnancy. It does not exclude the possibility that the glucose intolerance preceded the pregnancy or that medication might be required for optimal glucose control. Women diagnosed with gestational diabetes should be retested 6 to 12 weeks after the pregnancy ends. |
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Term
| Risks associated with poor glycemic control |
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Definition
Poor glycemic control around the time of conception and in the early weeks of pregnancy is associated with an increased incidence of miscarriage.
Poor glycemic control later in preganncy, particularly in women without vascular disease, increases the rate of fetal macrosomia. |
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Term
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Definition
Birth weight more than 4000 grams or greater than the 90th percentile.
Poor glycemic control later in pregnancy, particularly in women without vascular disease, increases the rate of fetal macrosomia. |
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Term
| Diabetic ketoacidosis in pregnancy occurs at what bcg? |
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Definition
| DKA may occur with blood glucose levels barely exceeding 200 mg/dL, compared with 300-350 mg/dL in the nonpregnant state. |
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Term
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Definition
| Hemoglobin A1c levels greater than 6 indicate elevated glucose levels during the previous 4 to 6 weeks. |
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Term
| Normal blood glucose levels |
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Definition
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Term
| What should you do if contractions start during exercise? |
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Definition
| The woman should be advised to stop exercising immediately if they are detected, drink two to three glasses of water, and lie down on her side for an hour. If the contractions continue, she should contact her health care provider. |
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Term
| Normal blood glucose values for a pregnant woman |
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Definition
| Fasting levels are generally between 65 and 95 mg/dL, and 1-hour postmeal levels should be less than 130 to 140 mg/dL. Two-hour postmeal levels should be 120 mg/dL or less. The woman should report episodes of hypoglycemia (less than 60 mg/dL) and hyperglycemia (more than 200 mg/dL) immediately. |
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Term
| What is the difference between plasma glucose values and whole blood glucose values? |
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Definition
| Most of the newer reflectance meters are calibrated to provide plasma (rather than whole blood) glucose values. Plasma glucose values are 10% to 15% lower than those measured in whole blood from the same sample. |
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Term
| Classic risk factors for GDM |
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Definition
| family history of diabetes, previous pregnancy that resulted in an unexplained stillbirth or the birth of a malformed or macrosomic fetus, obesity, hypertension, glycosuria, maternal age older than 25 years. |
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Term
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Definition
| A two-step screening method generally is used. The first step is a screen consisting of a 50 g oral glucose load followed by a plasma glucose measurement 1 hour later. The woman need not be fasting when the screen is done. A glucose value of 130 to 140 mg/dL is considered a positive screen. This is followed by step 2, a 3-hour (100-g) oral glucose tolerance test (OGTT). |
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Term
| What is the standard diabetic diet in terms of the amount of calories? |
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Definition
| 30 kcal/kd/day based on a normal preconception weight. 25 kcal/kg/day or less for obese women. |
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Term
| Typical schedule for BCG monitoring |
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Definition
| test upon rising in the morning, after breakfast, before and after lunch, after dinner, and at bedtime. |
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Term
| Most frequently prescribed oral anti-diabetic medication for pregnant women and why? |
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Definition
| Glyburide because only minimal amounts of glyburide cross the placenta (Metformin, another oral anti-diabetic agent, crosses the placenta but does not appear to be teratogenic). |
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Term
| Most frequently prescribed medications for hyperthyroidism in pregnant women |
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Definition
Propylthiouracil (PTU), is recommended for the first trimester.
Methimazole (MM), recommended for the second and third trimesters.
After birth, take meds right after breastfeeding thus allowing 3-4 hour period before nursing again. |
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Term
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Definition
| Phenylketonuria (PKU), a recognized cause of cognitive impairment, is an inborn error of metabolism caused by an autosomal recessive trait that creates a deficiency in the enzyme phenylalanine hydrolase. Absence of this enzyme impairs the ability of the body to metabolize the amino acid phenylalanine found in all protein foods. Toxic accumulation of phenylalanine in the blood occurs, which interferes with brain development and function. |
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Term
| Atrial septal defect (ASD) |
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Definition
An abnormal opening between the atria. It is one of the causes of a left-to-right shunt and one of the most common congenital defects seen during pregnancy. This defect may go undetected because the woman is usually asymptomatic. The pregnant woman with an ASD usually has an uncomplicated pregnancy. However, some women may develop congestive heart failure, arrhythmias, or emboli.
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Term
| Ventricular septal defect (VSD) |
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Definition
An abnormal opening between the ventricles, another cause of a left-to-right shunt. It may occur as a single lesion or in combination with other cardiac anomalies such as tetralogy of Fallot. Usually diagnosed and corrected early in life. For women with a large VSD, there is a higher risk for CHF or pulmonary hypertension. Medical management includes administration of anticoagulants, rest and decreased activity.
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Term
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Definition
Coarctation of the aorta is a localized narrowing of the aorta near the insertion of the ductus. Patients with this lesion have hypertension in their upper extremities but hypotension in the lower extremities. Complications that can occur include hypertension, congestive heart failure, cerebrovascular accident (stroke), aortic dissection, and rupture of associated aneurysms.
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Term
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Definition
Components of tetralogy of Fallot include a VSD; pulmonary stenosis; overriding aorta; and right ventricular hypertrophy, leading to a right-to left shunt. women with uncorrected tetralogy of Fallot experience more right-to-left shunting during pregnancy, resulting in reduced blood flow through the pulmonary circulation and increasing hypoxemia, which can cause syncope or death.
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Term
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Definition
In MVP the mitral valve leaflets prolapse into the left atrium during ventricular systole, allowing some backflow of blood. Midsystolic click and late systolic murmur are hallmarks of this syndrome. Most cases are asymptomatic. A few women have atypical chest pain (sharp and located in the left side of the chest) that occurs at rest and does not respond to nitrates. They may also have anxiety, palpitations, dyspnea on exertion, and syncope.
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Term
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Definition
| Almost always caused by rheumatic heart disease. Mitral stenosis is a narrowing of the opening of the mitral valve caused by stiffening of valve leaflets, which obstructs blood flow from the atrium to the ventricle. As the mitral valve narrows, dyspnea worsens, occurring first on exertion and eventually at rest. A tight stenosis plus the increase in blood volume and cardiac output of normal pregnancy may cause pulmonary edema, a-fib, right-sided heart failure, infective endocarditis, pulmonary embolism, and massive hemoptysis. |
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Term
| Peripartum cardiomyopathy (PCM) |
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Definition
| CHF w/ cardiomyopathy. Criteria for PCM include development of CHF during the last month of pregnancy or within the first 5 postpartum months; absence of heart disease before the last month of pregnancy; a left ventricular ejection fraction of less than 45%; and lack of another cause for heart failure. Risk factors include maternal age older than 30 years, multiparity, African descent, obesity, tocolytic use, preeclampsia, and chronic hypertension. Management of PCM: diuretics, sodium and fluid restriction, afterload-reducing agents, and digoxin. |
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