Gestational & Pregestational Diabetes Management Flashcards

What are the ADA-recommended blood glucose targets for women with gestational diabetes?

Answer: Fasting <95 mg/dL, 1-hr postprandial <140 mg/dL, 2-hr postprandial <120 mg/dL

ADA GDM targets are fasting <95 mg/dL, 1-hour postprandial <140 mg/dL, and 2-hour postprandial <120 mg/dL—stricter than standard non-pregnancy targets.

What is the preferred first-line pharmacologic treatment when lifestyle modifications are insufficient for GDM?

Answer: Insulin therapy because it does not cross the placenta

Insulin is the preferred first-line agent for GDM requiring pharmacotherapy because it does not cross the placenta and has the most established pregnancy safety profile.

Which insulin type is most appropriate for addressing postprandial glucose excursions in a woman with GDM?

Answer: Rapid-acting insulin analogs (lispro or aspart) dosed with meals

Rapid-acting analogs (lispro, aspart) are preferred for postprandial coverage in GDM due to their convenient mealtime dosing and established safety in pregnancy.

A GDM patient on a carbohydrate-controlled diet has persistent fasting glucose 105-115 mg/dL but acceptable postprandial values. What is the most appropriate pharmacologic intervention?

Answer: Bedtime NPH or basal insulin to suppress overnight hepatic glucose output

Isolated fasting hyperglycemia in GDM is driven by unrestrained overnight hepatic glucose production and is best addressed with bedtime intermediate or basal insulin.

Why is glyburide no longer considered first-line pharmacotherapy for GDM in current clinical guidelines?

Answer: It crosses the placenta and is associated with increased neonatal hypoglycemia and macrosomia risk

Glyburide crosses the placenta and has been associated with higher rates of neonatal hypoglycemia and macrosomia compared to insulin, leading most guidelines to recommend insulin as first-line.

What macronutrient distribution is generally recommended for medical nutrition therapy in gestational diabetes?

Answer: 33-40% carbohydrate, 20-25% protein, 35-40% fat (moderate carbohydrate restriction)

GDM nutrition therapy typically recommends moderate carbohydrate restriction to 33-40% of calories to control postprandial glucose while providing adequate protein and fat.

What is the most significant fetal complication directly associated with poorly controlled gestational diabetes?

Answer: Fetal macrosomia leading to birth trauma and shoulder dystocia

Fetal macrosomia (large for gestational age) is the hallmark fetal complication of GDM, driven by excess glucose transplacental transfer causing fetal hyperinsulinemia and overgrowth, which can result in shoulder dystocia and operative delivery.