Gestational Diabetes

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Gestational Diabetes:

Gestational Diabetes

Risk Factors:

Risk Factors Previous diagnosis of gestational diabetes First degree relative with type 2 diabetes Increased maternal age African-American, Native American, Hispanic, South Asian Overweight of obese Previous high-birth weight child Smoking Polycystic ovarian syndrome

Pathophysiology:

Pathophysiology Cortisol and progesterone mediate insulin resistance in second trimester. Patients can’t compensate with increased production of beta cells. Fetus is exposed to higher glucose levels. Increased levels of fetal insulin Excessive growth and large body of fetus Increased insulin production and susceptibility to hypoglycemia after birth

Screening:

Screening Non-challenge blood glucose tests Moderate sensitivity, high false positives Screening glucose challenge test Detects 80-90% of patients Oral glucose tolerance test Urinary glucose test Low sensitivity and positive predictive value

Management:

Management Control of glucose levels Regular moderately intense physical exercise Insulin therapy Glyburide and Metformin Important: Preterm delivery is more common in insulin treated patients.

Prognosis:

Prognosis Generally resolves once baby is born 30-84% chance for following pregnancy Increased risk of diabetes mellitus in future Children at higher risk for childhood and adult obesity and type 2 DM

Complications:

Complications Macrosomia Instumental deliveries Shoulder dystocia Hypoglycemia Jaundice Polycythemia Hypocalcemia Hypomagnesemia

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