Carbohydrate Intolerance During Pregnancy: Risks & Diagnosis
Carbohydrate intolerance during pregnancy, known as gestational diabetes mellitus (GDM), can lead to various risks for both the fetus and the mother. Understanding the physiology of glucose metabolism, increased risks, diagnosis criteria, and strategies for managing GDM are crucial for maternal and fetal health. Risks include macrosomia, neonatal hypoglycemia, preeclampsia, and increased risk of Type 2 diabetes. Screening all pregnant women for GDM is essential to identify and manage this condition early on.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
Definition Carbohydrate intolerance that begins or is first recognized during pregnancy (7% of all pregnancies in the United States)
Physiology of Glucose Metabolism of Pregnancy Early pregnancy- HYPOglycemia Later pregnancy- HYPERglycemia
Increase in Insulin Resistance Human Placental Lactogen Produced by Growing Placenta
Increased maternal glucose levels Macrosomia in infant Increased insulin production in infant Maternal glucose removed at birth Neonate becomes hypoglycemic
Increased Risks for Fetus and Newborn 1. 2. 3. 4. 5. 6. 7. Macrosomia Shoulder dystocia Birth injuries Hyperbilirubinemia Hypoglycemia / Fetal Hyperinsulinemia ( cord blood C-peptide) Respiratory distress syndrome Childhood obesity
Increased Maternal Risks 1. 2. 3. Preeclampsia Caesarean Delivery Increased risk of developing Type 2 Diabetes later in life
Diagnosis All pregnant women should be screened for GDM, whether by patient history, clinical risk factors, or a nonfasting 50 g, 1hourloading test at 24-28 weeks gestation to determine blood glucose levels. 130 mg/dL : 90% sensitivity, 87% specificity 140 mg/dL: 80% sensitivity, fewer false positives
Low-risk individual A. Age younger than 25 yrs B. Not a member of an ethnic group with an increased risk for the development of type 2 diabetes (Hispanic, African, Native American, South or East Asian, or Pacific Islands ancestry) C. Body mass index of 25 or less D. No previous history of abnormal glucose tolerance E. No previous history of adverse obstetric outcomes usually associated with GDM F. No known diabetes in first degree relative
Diagnosis The diagnosis of GDM can be made based on the result of the fasting100g, 3 hour oral glucose tolerance test, for which there is evidence that treatment improves outcome. -Administered in morning after overnight fast -Do not smoke before the test -Remain seated during the test -Follow unstructured diet, consuming at least 150 g of CHO/day for at least 3 days prior to the test (avoids CHO depletion, which could cause spuriously high values on GTT)
Diagnosis of GDM Status Carpenter/Coustan Plasma or Serum Glucose Level (mg/dL) National Diabetes Data Group Plasma Level (mg/dL) Fasting 95 105 1 hour 180 190 2 hours 155 165 3 hours 140 145 A positive diagnosis requires that two or more thresholds be exceeded
Diagnosis Diagnosis of GDM based on the 75 g, 2 hour glucosetolerance test outlined by the International Association of Diabetes in Pregnancy Study Group (IASPSG) is not recommended at this time because there is no evidence that diagnosis using these criteria leads to clinically significant improvements in maternal or newborn outcomes. Would result in GDM being diagnosed in 18% of pregnant women. Also, significant increase in health care costs.
Diagnosis NIH panel March 2013 believes that there is not sufficient evidence to adopt a one-step approach, such as that proposed by the IADPSG. Thus, the panel recommends that the two-step approach be continued. ACOG also recommends two-step approach at this time (9/2011).
Management Diet 30 kcal/kg/day of ideal body weight 40% complex CHO, 35% fat, 20% protein Blood Glucose Monitoring Fasting glucose levels < 95 mg/dL 1 hr postprandial values < 130-140 mg/dL 2 hr postprandial < 120 mg/dL When medical nutritional therapy has not resulted in these values, start insulin.
Management Insulin requirements increase throughout pregnancy, most markedly between 28-32 weeks gestation 0.7 -0.8 U/ kg/ day 1st trimester 0.8 1 U/ kg/ day 2nd trimester 0.9- 1.2 U/ kg/ day 3rd trimester
Name Onset of Action Peak Action (hrs) Duration of Action (hrs) Rapid Lispro (Humalog) 10 minutes 1-2 4 Short Regular 30 minutes 2-4 6-8 Intermediate NPH 1-2 hours 6-12 18-24 Long Glargine (Lantus) 1-2 hours No peak 20-24
Insulin Rapid or short acting insulins are administered before meals to reduce glucose elevations before eating. Regular insulin is given 30 minutes prior to eating. Lispro should be given immediately before eating (can cause significant hypoglycemia in the unprepared pt). Longer acting insulin are used to restrain hepatic glucose production between meals and in the fasting state. Lantus given as once daily dosing (24-hour duration) in AM or PM. Creates steady basal insulin state with no peak. Intermediate-acting insulin is usually given before breakfast with rapid/short acting insulin and before evening meal or at bedtime. Bedtime dosing is preferred to avoid nocturnal hypoglycemia.
Pregestational Diabetes Mellitis Approximately 1-2% of all pregnant patients (less than gestational diabetes)
White Classification Age of onset Duration of Diabetes Renal Complications (Class F) Proliferative Retinal Complications (Class R) Cardiac Complications (Class H)
