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     2  Defined Complicates 3-5% of all pregnancies! Glucose intolerance identified during pregnancy Accounts for more gestational complications than any other adverse factors!
     3  ETIOLOGY Most women revert back to euglycemia post-partum HPL- human placental lactogen stimulates insulin release HPL also decreases glucose uptake & gluconeogenesis …mom gets progressively more insulin resistant as pregnancy progresses!!!
     4  ETIOLOGY con’d Estrogen & progesterone also increase during pregnancy and in turn increase maternal insulin levels!! As the placenta grows it releases more & more hormones(HPL) included. As the pregnancy progresses into the 3rd trimester hyperinsulinemia & hyperglycemia!!!
     5  Etiology con’d The pathologic defect in GDM is a diminished compensatory response to the increased insulin resistance commonly associated with pregnancy!!
     6  RISK FACTORS - Environ/Maternal Obesity (60-80%) Age >30 Previous delivery of infant> 4000gms Previous unexplained stillbirth Multiple spontaneous abortions Persistent gylcosuria
     7  RISK FACTORS - Hereditary Family History of DM in a first degree relative of Latino, African American, Asian, or Native American background.
     8  Gold standard Screen everyone at 28 wks gestation! 50 gm oral glucose load on a fasting stomach. Glucose level 1 hour later
     11  Fetal Complications Macrosomia - weight > 90th percentile for a given gestational age. Shoulder dystocia Dystocia
     12  Congenital malformations Heart CNS Kidneys Skeleton
     13  Neonatal Hypoglycemia Blood glucose < 30mg/dL Fetal hypertrophy of pancreatic tissue & secretion of more insulin
     14  Newborns also at greater risk for... Hyperbilirubinemia Hypocalcemia Polycythemia Infants will present with irritability, respiratory distress, apnea, hypotonia, lethargy & cyanosis
     15  Maternal Risks Polyhydramnios 10% of GDM amniotic fluid > 2000 mL increased risk of abruptio placentas preterm labor postpartum uterine atony
     16  Maternal Risks C-section - 3 times more likely to have Infection (UTI) Chronic Hypertension Preeclampsia Eclampsia Retinopathy 50% will go on to develop DM at some point in their lives!!
     17  TREATMENT GDM DIET 50-55% CHO ( complex & fiber best) 20-30% fat 20-30% protein
     18  TREATMENT 10-15% of GDM’s go on to require Insulin Daily glucose monitoring 7 times! If strict glycemic control is achieved these women are at no greater risk of having macrosomic infants!
     19  Oral hypoglycemic agents Not successfully studied! Have same effect on fetal pancreas as moms! Infants experience prolonged hypoglycemia (4-10 days) to moms who took sulfonylureas