{"id":4422495,"date":"2025-01-11T21:23:12","date_gmt":"2025-01-12T03:23:12","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/topics\/diabetes-in-pregnancy\/"},"modified":"2025-01-12T12:25:22","modified_gmt":"2025-01-12T18:25:22","slug":"diabetes-in-pregnancy","status":"publish","type":"oen_topic","link":"https:\/\/myendoconsult.com\/learn\/topics\/diabetes-in-pregnancy\/","title":{"rendered":"Diabetes in Pregnancy"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">DIABETES MELLITUS IN PREGNANCY<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Most common medical complication of pregnancy.<\/strong><\/li>\n\n\n\n<li><strong>Gestational <a href=\"https:\/\/myendoconsult.com\/learn\/diabetes-mellitus\/\" data-wpil-monitor-id=\"238\">Diabetes Mellitus<\/a> (GDM):<\/strong> occurs in 4% of pregnancies.<\/li>\n\n\n\n<li><strong>Pregestational Diabetes (Type 1 or Type 2):<\/strong> affects ~0.5% of pregnancies.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Importance of Glycemic Control<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Poorly controlled diabetes<\/strong> \u2192 high risks for:\n<ul class=\"wp-block-list\">\n<li>Spontaneous abortion<\/li>\n\n\n\n<li>Major congenital malformations<\/li>\n\n\n\n<li>Preterm birth<\/li>\n\n\n\n<li>Preeclampsia<\/li>\n\n\n\n<li>Stillbirth<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Pathophysiology:<\/strong> maternal hyperglycemia \u2192 fetal hyperglycemia \u2192 fetal hyperinsulinemia \u2192 increased fetal growth (macrosomia).<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Fetal Macrosomia<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Definition:<\/strong> fetal birth weight &gt;4500 g.<\/li>\n\n\n\n<li>Leads to <strong>delivery complications<\/strong> (e.g., shoulder dystocia) and <strong>risk of birth trauma<\/strong>.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">PHYSIOLOGIC CHANGES &amp; DIAGNOSIS<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Normal Pregnancy Glucose Metabolism<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>First Trimester<\/strong>: rising estrogen &amp; progesterone \u2192 <strong>\u2193 fasting plasma glucose<\/strong> (by ~15 mg\/dL).<\/li>\n\n\n\n<li><strong>Second &amp; Third Trimesters<\/strong>: increased <strong>human chorionic somatomammotropin (hCS)<\/strong> or <strong>human placental lactogen<\/strong> \u2192 <em><a href=\"https:\/\/myendoconsult.com\/learn\/mechanism-of-action-of-growth-hormone\/\" data-wpil-monitor-id=\"239\">growth hormone\u2013like action<\/a><\/em> that promotes lipolysis and antagonizes insulin \u2192 <strong>mild hyperglycemia<\/strong>.<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Definitions for Diabetes in Pregnancy<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Pregestational diabetes<\/strong> (type 1 or 2) follows standard diagnostic criteria.<\/li>\n\n\n\n<li><strong>Gestational <a href=\"https:\/\/myendoconsult.com\/learn\/glucose-bad-mnemonic\/\" data-wpil-monitor-id=\"240\">Diabetes Mellitus<\/a> (GDM)<\/strong>: hyperglycemia first recognized during pregnancy.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Screening &amp; Testing<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Universal screening<\/strong> recommended between <strong>24\u201328 weeks<\/strong> gestation.<\/li>\n\n\n\n<li>Earlier screening if high risk (BMI &gt;30, history of GDM, prior infant with malformation, or strong family history of diabetes).<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">One-Step Approach<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>50-g Oral Glucose Challenge Test (GCT)<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Measure plasma glucose at 1 hour.<\/li>\n\n\n\n<li>If &gt;130 mg\/dL (some use 140 mg\/dL), proceed to 3-hour 100-g <a href=\"https:\/\/myendoconsult.com\/learn\/oral-glucose-tolerance-test\/\" data-wpil-monitor-id=\"244\">Oral Glucose Tolerance Test<\/a> (OGTT).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Diagnostic 3-hour 100-g OGTT<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>GDM confirmed if \u22652<\/strong> of these plasma glucose values are met\/exceeded:\n<ul class=\"wp-block-list\">\n<li>Fasting: <strong>\u226595 mg\/dL<\/strong><\/li>\n\n\n\n<li>1 hour: <strong>\u2265180 mg\/dL<\/strong><\/li>\n\n\n\n<li>2 hours: <strong>\u2265155 mg\/dL<\/strong><\/li>\n\n\n\n<li>3 hours: <strong>\u2265140 mg\/dL<\/strong><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Exception<\/strong>: If 1-hour GCT &gt;180 mg\/dL and <strong>fasting &gt;95 mg\/dL<\/strong>, GDM is confirmed without needing the OGTT.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">MANAGEMENT OF GDM<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Lifestyle Therapy<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Daily exercise<\/strong> (as tolerated).<\/li>\n\n\n\n<li><strong>Nutrition therapy<\/strong> with calorie allotment, <em>mild carbohydrate restriction<\/em> (33\u201340% of total calories).<\/li>\n\n\n\n<li><strong>Self-monitoring of blood glucose<\/strong> (SMBG) \u22654 times\/day (fasting + postprandial).<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Glycemic Targets in Pregnancy<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fasting plasma glucose: <strong>70\u201395 mg\/dL<\/strong><\/li>\n\n\n\n<li>1\u20132 hour postprandial glucose: <strong>&lt;120 mg\/dL<\/strong><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Pharmacotherapy<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>About <strong>15%<\/strong> of GDM <a href=\"https:\/\/myendoconsult.com\/learn\/types-of-insulin-pens\/\" data-wpil-monitor-id=\"241\">patients require insulin<\/a> if lifestyle alone isn\u2019t enough.<\/li>\n\n\n\n<li><strong>Insulin dosing<\/strong> individualized to meet above glucose targets.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Monitoring Pregnancy<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Ultrasound<\/strong> for fetal growth, amniotic fluid volume.<\/li>\n\n\n\n<li>Evaluate &amp; treat:\n<ul class=\"wp-block-list\">\n<li>Hypertension\/preeclampsia<\/li>\n\n\n\n<li>Diabetic retinopathy (especially in pregestational diabetes)<\/li>\n\n\n\n<li>Ketoacidosis<\/li>\n\n\n\n<li>Urinary tract infections<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Postpartum &amp; Future Risk<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Glucose often returns to normal postpartum in GDM patients, but:\n<ul class=\"wp-block-list\">\n<li><strong>60%<\/strong> risk of GDM recurrence in subsequent pregnancies.<\/li>\n\n\n\n<li><strong>50%<\/strong> develop <a href=\"https:\/\/myendoconsult.com\/learn\/topics\/type-2-diabetes\/\" data-wpil-monitor-id=\"242\">type 2 diabetes<\/a> in next 10 years.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">LONG-TERM EFFECTS ON OFFSPRING<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fetal hyperinsulinemia &amp; excess fat deposits<\/strong> in utero \u2192 linked to:\n<ul class=\"wp-block-list\">\n<li>Childhood obesity<\/li>\n\n\n\n<li><a href=\"https:\/\/myendoconsult.com\/learn\/homa-ir-calculator\/\" data-wpil-monitor-id=\"243\">Insulin resistance<\/a><\/li>\n\n\n\n<li>Future impaired glucose tolerance or diabetes as adults.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>DIABETES MELLITUS IN PREGNANCY Importance of Glycemic Control Fetal Macrosomia PHYSIOLOGIC CHANGES &amp; DIAGNOSIS Normal Pregnancy Glucose Metabolism Definitions for Diabetes in Pregnancy Screening &amp; Testing One-Step Approach Diagnostic 3-hour 100-g OGTT MANAGEMENT OF GDM Lifestyle Therapy Glycemic Targets in Pregnancy Pharmacotherapy Monitoring Pregnancy Postpartum &amp; Future Risk LONG-TERM EFFECTS ON OFFSPRING<\/p>\n","protected":false},"featured_media":0,"template":"","oen_topic_chapter":[686],"class_list":["post-4422495","oen_topic","type-oen_topic","status-publish","hentry","oen_topic_chapter-the-pancreas","post-wrapper","thrv_wrapper"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422495","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/oen_topic"}],"version-history":[{"count":4,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422495\/revisions"}],"predecessor-version":[{"id":4422741,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422495\/revisions\/4422741"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=4422495"}],"wp:term":[{"taxonomy":"oen_topic_chapter","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic_chapter?post=4422495"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}