Gestational Diabetes Mellitus

Definition Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may ha e antedated or begun concomitantly with the pregnancy.

Classification

There are 2 classes of gestational diabetes (diabetes which began during pregnancy) Class A1: gestational diabetes; diet controlled Class A2: gestational diabetes; medication controlled

The second group of diabetes which existed before pregnancy can be split up into these classes: Class B: onset at age 20 or older or with duration of less than 10 years Class C: onset at age 10-19 or duration of 1019 years Class : onset before age 10 or duration greater than 20 years

Class !: o"ert diabetes mellitus with calcified #el"ic "essels

Class $: diabetic nephropathy is a progressive kidney disease caused by angiopathy of capillaries in thekidney glomeruli. It is characterized by nephrotic syndrome and diffuse glomerulosclerosis. It is due to longstanding diabetes mellitus, and is a prime indication for dialysis

Class %: #roliferati"e retino#athy Class %$: retino#athy and ne#hro#athy Class &: ischemic heart disease Class ': #rior (idney trans#lant

An early age of onset or long-standing disease comes with greater ris(s) hence the first three subty#es*

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<=I> Gestational Diabetes <uiz &. ?yperglycemia during pregnancy is associated with increased incidence of all of the following except@ "0 Aetal macrosomia )0 %ligohydramnios 60 $eonatal hypoglycemia D0 /reeclampsia

,. "ll of the following are risB factors for gestational diabetes (GDM) except0 "0 Maternal age greater than ,4 )0 Maternal weight greater than 2( Bg 60 Mother with pre ious infantCs birth weight greater than - Bg D0 GDM with pre ious pregnancy D0 Aamily history of GDM

-. Ehich of the following is true about screening for GDM in a patient without risB

factors@ "0 *hould be performed at initial isit )0 *hould be performed at ,13,5 weeBs of gestation 60 *hould be performed at -4 weeBs of gestation D0 Initial screening test is a - hour oral glucose tolerance test

1. Eith regard to GDMF all of the following are true except@ "0 " positi e screen for random 4( g & hr oral glucose challenge is a serum glucose G &-2 mg8dH )0 Airst trimester screening should be performed in motherCs with G , risB factors 60 /atient must be fasting for - hr oral glucose tolerance test D0 ?gb "&6 should be checBed as part of initial screen in all %) patients

4. Ehich of the following is not a diagnostic criteria for DM in non3pregnant

patients@ "0 Iandom plasma glucose G &1( mg8dH )0 /olyuriaF polydipsiaF and polyphagia in setting of unexplained weight loss 60 Aasting plasma glucose greater than &,: mg8dH on two occasions D0 Two hr plasma glucose le el greater than ,(( mg8dH during a '4 gF , hr oral glucose tolerance test

:. Ehich of the following is true about gestational diabetes screening@ "0 Howering the screening glucose le el indicating an abnormal result for the glucola test would lead to fewer false positi e results )0 Howering the screening glucose le el indicating an abnormal result for the glucola test would decrease the testCs sensiti ity 60 =sing historical risB factors alone (without glucola test) would miss J4(K of patients with GDM D0 " serum glucose of &,5 mg8dH in a & hr glucola test is positi e according to "6%GCs guidelines

'. /atients with hypertension and DM are at higher risB for all of the following except0 "0 Intrauterine growth restriction )0 $uchal cord 60 "bruptio placentae D0 Maternal stroBe

5. Iecs for serum glucose management in patients with GDM include all of the following except@ "0 Iecord blood glucose fasting as well as & and , hr postprandial le els )0 6arbohydrate intaBe at breaBfast should be limited 60 Most patients with GDM diagnosed in the third trimester can maintain &3hour postprandial blood glucose le els L&-( mg8dH ia diet manipulation D0 &( Bcal8Bg8day diet based upon current pregnancy weight

2. Ehich of the following is true about the use of oral hypoglycemic agents in pregnancy@

"0 %nce glycemic control was achie edF no significant difference in fetal outcome was found between groups treated with insulin and sulfonylureas )0 Glyburide has the highest rate of maternal3fetal transfer of all sulfonylureas 60 Metformin is always first line therapy D0 Glyburide has been pro en safe to use during all three trimesters

&(. Ehich of the following is true for postpartum management in a patient with GDM@ "0 Target serum glucose le els are L 2( mg8dH for fasting checBs and L &&4 mg8dH for & hr postprandial checBs )0 /atients should be on an "D" diet for one year after deli ery 60 "n oral glucose tolerance test should be repeated J :35 weeBs after deli ery D0 /atients who had GDM should not breastfeed http088academicdepartments.musc.edu8family;medicine8Iesidency/rogram8<uiz K,(GestationalK,(Diabetes:.

&. Ehen does gestational diabetes usually de elop@ ". &st trimester ). ,nd trimester 6. -rd trimester ,. Ehich one of these is not considered a risB for gestational diabetes@ ". %besity ). Aamily history of Diabetes 6. /re ios large baby D. $one of the abo e -. If the motherCs has too much glucoseF the baby will con ert the extra glucose to fat. This is what causes the baby to grow considerably large@ ". True ). Aalse 1. Ehich one of the following is not considered a complication that may affect the baby@ ". Iespiratory distress ). ?ypoglycemia 6. ?yperacti ity D. Damage to the babyCs shoulder to macrosomia

4. "ll women who test positi e after the 4( gram glucose3screening will ha e geststional diabetes@ ". True ). Aalse :. Ehich one of the following is not a complication for women with gestational diabetes@ ". /reeclampsia ). 6esarean section 6. Irritability '. Ehat can be done to pre ent permannet diabetes in the mother@ ". Diet and execise ). %nly eat 9unB food on weeBend 6. )edrest D. $one of the abo e 5. Ehat can be done to pre ent diabetes in children or babies@ ". )reast3feeding for at least the first - months ). Teaching children to eat right at an early age 6. )oth " and ) http088gilbert55.wordpress.com8,((58('8&48gestational3diabetes3Muiz8 -. Ehich of the following is considered a risB factor for gestational diabetes@

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). %besity

6. Aamily history of diabetes

D. "ll of the abo e Your answer d is correct. "lthough any woman can de elop gestational diabetes during pregnancyF some of the factors that may increase the risB include the following0

obesity family history of diabetes ha ing gi en birth pre iously to a ery large infantF a still birthF or a child with a birth defect

ha ing too much amniotic fluid (polyhydramnios) age