Diabetes in Pregnancy

Diabetes in Pregnancy: Care PrinciplesElizabeth Guevara, FNP-BCMaternal Fetal Medicine - DM

1Why Do We Care?

Insulin Requirements

Blood Glucose Ranges

GDM Background & Incidence1964: Formal diagnostic criteria established for gestational diabetes based on mothers increased risk of future development of diabetes lifetime risk of diabetes exceeded 70%GDM incidence in U.S. formerly ~2-10%, now estimated ~18% with the ADA-endorsed IADPSG 2011 criteriaChange from 2-step diagnosis (50 gm screen with 100 gm 3-hr GTT confirmation) to 75 gm 2-hr GTT

GDM: Recurrence Risk35-80% risk of GDM recurrenceHigher risk of recurrence if:Parity: >1 in 1st GDM pregnancyGreater infant birth weight in 1st GDM pregnancyMaternal obesity (BMI > 30)Early GDM ( 7 kg in 1st GDM pregnancyInterval between pregnancies < 24 months

GDM: Future T2DM RiskThe closer you are to diabetes in pregnancy, the sooner you will become diabetic. Variable quoted rates of conversion to T2DM22% some degree of glucose intolerance in immediate postpartum period (2-hr GTT @ 6-8 wks PP)3.2% impaired fasting glucose (IFG)11% impaired glucose tolerance (IGT)2.1% both IFG and IGT5.8% (~5-10%) overt T2DM20-50% risk over the 10 years following pregnancy: marked increased risk in first 5 years then plateaus after 10 years35-60% chance of developing T2DM in the following 10-20 years

GDM: PP T2DM Risk FactorsImpaired glucose tolerance postpartumElevated fasting glucose during pregnancy: FPG > 121 in pregnancy risk 21-foldObesity, especially abdominal obesityPostpartum weight gainEarly GDM diagnosis (