9-1: 11/8: Pathology Of Diabetes In Pregnancy

Front 1

Type I DM effect on fetus.

Back 1

Intrauterine Growth Restriction (probably long-standing DMI with retinal or renal complications)

10% of DM in pregnancy

Front 2

Screening Test for GDM
When is it performed?
Cutoffs?

Back 2

Performed at 24-28 weeks

50g glucose orally when fasting, and measure glucose at 1 hour
If >130, do GTT (must then have 2 values above reference range!)
If >195, GTT = POSITIVE

Front 3

Risk factors for diabetic embryopathy.

HbA1C cutoffs.

Prevention?

Back 3

Poor control with hypergly
10 year hx of DM
Diabetic vascular dz

HbA1C<8.5%: rate of defects = 3.4%
HbA1C>8.5%, rate of defects = 22.4%

Prevention must occur early on, not at 24 weeks, relevant to known diabetics!

Front 4

Signs of diabetic embryopathy.

Back 4

Caudal regression
NT defects
Holoprosencephaly
CV anomalies

Front 5

Diabetic fetopathy vs embryopathy (general: occurrence)

Back 5

Diabetic fetopathy can occur with either preexisting or gestational diabetes

Diabetic embryopathy occurs almost exclusively with preexisting diabetes

Front 6

Fetal response to hyperglycemia.

Back 6

Inc'd fetal insulin-->growth stimulus (confined to fetal/neonatal period)

Results in fetal macrosomia

Front 7

Define fetal macrosomia.

Include brain/liver ration.

Back 7

Weight >4000g (at birth)

*exceeds 90th percentile

Accompanied by visceromegaly, but brain spared

Placenta is also large

Brain/liver ratio: 2/1 (normally 3/1)

Front 8

Effect of diabetes on CV system.

Back 8

Hypertrophic CM involving BOTH ventricles

May show asymmetrical septal hypertrophy

Resolves if infant survives

Front 9

How does diabetes cause fetal hypoxia?

Back 9

Maternal causes: vasculopathy, ketoacidosis (alters HbO2 dissociation curve)

Dec'd uteroplacental blood flow due to hyperglycemia, ketoacidosis, or pre-eclampsia

Fetal Causes: hyperglycemia, hyperinsulinemia, ketonemia

Front 10

What is Erb's palsy?

Back 10

Shoulder dystocia due to macrosomia and subsequent brachial plexus injury.

Front 11

Glucose cutoffs for postnatal hypoglycemia.

Back 11

Glucose values:
Low birth weight <20
Full sized: <30 in first 48 hours; then <40-50

Front 12

Effects of DM on fetal pancreas.

Electrolyte effects?

Back 12

enlarged islets (hypertrophy)
pleomorphism
hyperchromatism of BETA-CELL nuclei
EOSINOPHILS in and around islets

HYPOCALCEMIA FOR SOME REASON

Front 13

Effect of DM on lung development.

Back 13

Delayed lung development and delayed surfactant production-->RESPIRATORY DISTRESS SYNDROME

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Placenta in DM; this is large, weighing 1015 g. Mean placental weight is 432g at 37 weeks.

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