dm

• Random glucose level

  >200mg/dL
• Fasting glucose

  >125mg/dL
• Hemoglobin A1C


  >6.5%
• DM

  Diabetes Mellitus
• EPI

  Patients who have this typically have undiagnosed Type 2 Diabetes Mellitus
• Complications of DM in pregnancy

  • Spontaneous abortion
  • Preterm delivery
  • Altered growth like intrauterine growth restriction or macrosomia
• Treatment of DM in pregnancy

  1. Preconception care of glucose optimization, hemoglobin A1C <7%

  2. 1st trimester: carefully monitor and educate

  3. Insulin therapy to control glucose levels

  4. Diet of nutrition planning, 175g min carbs/day, not recommended weight loss

  5. Hypoglycemia is common in first semester
• 2nd trimester management

  1. Alpha-fetoprotein levels can be lowered in diabetic pregnancy

  2. Fetal echocardiogram due to increased risk of fetal heart defects

  3. Glycemic control is more stable than 1st trimester
• 3rd trimester management

  1. Fetal surveillance like growth ultrasound, non-stress test, biophysical profiles

  2. Labor induction is offered at 37/39 weeks
• Gestational Diabetes Mellitus (GDM)

  Carbohydrate intolerance of variable severity with onset variable severity, can cause excessive fetal growth aka macrosomia
• Screening for GDM

  1. 50g 1hr oral glucose challenge (50g GCT) between 24-28 weeks gestation

  2. If elevated 140mg/dL or more, then 100g 3hr glucose tolerance test for diagnosis
• Impact of GDM

  • Increased rate of malformations
  • Increased stillbirth
  • Fetal macrosomia causes increased risk of shoulder dystocia and need for C-section
  • Neonatal hypoglycemia
• Management of GDM

  1. Diet, exercise, glucose monitoring with fasting glucose <95 and 2hr postprandial <120

  2. Pharmacological therapy is insulin and oral hypoglycemic agents like glyburide or metformin

  3. Evaluate patient postpartum with a 75g oral glucose tolerance test