Term
| Best way to increase good outcomes |
|
Definition
Preconception counseling
Strict control of BS |
|
|
Term
| What to know about diabetic baby mortality |
|
Definition
Same mortality rate as all pregs
#1 cause of death is D/T anomalies |
|
|
Term
| What does insulin (beta cells) do? |
|
Definition
| Protein and fatty acid synthesis |
|
|
Term
| Diabetic changes over time |
|
Definition
Atherosclerosis
Retinopathy
Nephropathy
Neuropathy |
|
|
Term
___ crosses the placenta
___ does NOT cross the placenta |
|
Definition
Glucose crosses
Insulin does not cross |
|
|
Term
| When does the fetus secrete its own insulin? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Changes in the 1st trimester |
|
Definition
Insulin increases (D/T estro/prog)
HRF hypoglycemia
NO CHANGE in insulin resistance |
|
|
Term
|
Definition
BS <60
Irritable
Sweaty
Clammy
Hungry
Fatigued
Pallor
UA (-) for sugar/acetone |
|
|
Term
| Changes in the 2/3rd trimesters |
|
Definition
Decreased glucose tolerance
INCREASED insulin requirements/resistance
HRF DKA/hyperglycemia |
|
|
Term
|
Definition
BS >200
Thirsty
H/A
Polyuria
N/V
Weak
Acetone/fruity breath
UA (+) for sugar/acetone |
|
|
Term
| What hormones increase in the 2/3rd trimesters? |
|
Definition
HPL
Estrogen
Prolactin
Cortisol |
|
|
Term
| Events during placental expulsion |
|
Definition
Immediate decrease in cortisol & insulinase
Quick re-sensitivity to insulin (Breastfeeding moms take 6-9 mo) |
|
|
Term
| What is the best way to decrease congenital anomalies |
|
Definition
|
|
Term
| ___ ___ are teratogenic- D/C and place on ___ |
|
Definition
| Oral hypoglycemics; Insulin |
|
|
Term
| Two oral insulins that are safe for pregnancy |
|
Definition
|
|
Term
|
Definition
Increases insulin from pancreas
2.5 mg 2x/day (Max 10 mg 2x/day)
4-10 hours
ASA/H2 compete
Contraindicated w/ Liver, kid, sulfa allergy |
|
|
Term
|
Definition
Decreases hepatic glucose
W/hold 24 h b4, 48 h after contrast/HR
500 mg/day 48 hours
Ok for PCOS
Phototherapy, APGAR <7, RDS, premie
Contra: Hep/renal, dehyd, met acid, CHF |
|
|
Term
Poor control in:
1. Conception
2. Precon, conc, early
3. Later |
|
Definition
1. Miscarry
2. Anomaly, hypoglycemia
3. Macrosomia, hyperglycemia |
|
|
Term
|
Definition
Hydramnios (>2,000 ml/ 2L)
Increased urination
PROM |
|
|
Term
|
Definition
D/T vascular change
Retinopathy |
|
|
Term
|
Definition
Anti-insulin HPL
Poor motility
Develops slowly |
|
|
Term
|
Definition
IVF
Regular IV insulin
K+
Bicarb |
|
|
Term
|
Definition
Monolial vaginitis
UTI (D/T glycosuria) |
|
|
Term
|
Definition
Stillbirth 36 wks (Hypoxia)
Sacral agenesis (Lower limbs dont develop)
Macrosomia >4,000 g |
|
|
Term
| Infants of DM moms are HRF ___ in the first ___ minutes of life. |
|
Definition
Hypoglycemia
30-60 minutes |
|
|
Term
|
Definition
Increase in RBC = Decreased Hgb
Immature system causes hyperbilirubinemia |
|
|
Term
|
Definition
4-6 weeks
>8 is bad
Office 1/2x/wk 3rd tri |
|
|
Term
|
Definition
8% = 180 mg/dL
1% = (+/-) 30 mg/dL |
|
|
Term
| Calories in each trimester |
|
Definition
1st: 2200
2/3rd: 2500
Gain 12 kg |
|
|
Term
Blood glucoses
1. Preprandial
2. Postprandial |
|
Definition
1. Preprandial 65-105
2. Postprandial 1h <155
3. Postprandial 2h <130 |
|
|
Term
|
Definition
|
|
Term
|
Definition
Analogs: Humalog, Novolog, Apidra, Lantus, Levemir
8-24 h
* Lispro: FAST analog, immediately b4 food |
|
|
Term
| Target range for fasting BS and 2h postprandial BS |
|
Definition
Fasting: 60-90
Postprandial 2h: 90-120 |
|
|
Term
|
Definition
NST 2x/wk at 28-32 wks
NST/BPP q/wk at 32-36 wks |
|
|
Term
|
Definition
IV LR or D5 LR
BS q 2h (70-90)
Insulin w/ NS
No IV bolus w/ glucose
C/S in AM, 1st morning insulin held, NPO |
|
|
Term
|
Definition
Type 1 1st pp day: 1/4-1/3 insulin
Type 2 1st pp day: 40-50% or no insulin |
|
|
Term
|
Definition
Hypoglycemia
Hypocalcemia
Hyperbilirubinemia
Thrombocytopenia
Polcythemia
RDS |
|
|
Term
|
Definition
FSBS <105, 2h pp <120
Screen 24-28 wks
No protein, >20 wks |
|
|
Term
|
Definition
Give in GDM if BS >140
(+) = OGTT
2+ exceed 95-140, (+) GDM |
|
|
Term
|
Definition
|
|
Term
|
Definition
Future GDM
DM later
Carb intolerance 6-12 wks |
|
|
Term
|
Definition
Vomiting
<20 yo, obese, no smoking
Increased HCG, thyroid, stress
Decreased vit. B |
|
|
Term
|
Definition
High T4, low TSH
Tx: PTU, NO radioactive iodine!
HRF: Miscarry, LBW, preeclampsia |
|
|
Term
|
Definition
Everything is increased
Thyroid Storm: Fever, tachy, vomit, low BP, stupor, --> CHF
Tx: IVF, O2, PTU, K+ iodide, antipyretic, B blocker, sedate |
|
|
Term
|
Definition
Low T4, high TSH
Tx: Synthroid 2h b4/after Fe tabs
HRF: Preeclampsia, abrutpio, stillbirth, LBW, infertility |
|
|
Term
|
Definition
Everything is decreased
Fetal thyroid 12 wks |
|
|
Term
|
Definition
Toxic buildup of phenylalanine in brain b/c body can't produce the enzyme that breaks it down
D/C breastfeeding, phenyl-free formula |
|
|
Term
|
Definition
Phenylalanine-restricted diet WHOLE life (No cottage cheese, fish, poultry, meat, nuts)
No diet HRF: Miscarry, retard, microceph, cardiac, LBW
TERATOGENIC- Crosses placenta! |
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