NU 335 Maternity Chapter 17 Pregnancy at Risk: Pregestational Problems with 1005 complete solutions

What is the pathophysiology of Diabetes Mellitus? Endocrine disorder of carbohydrate metabolism -results from inadequate production or utilization of insulin -cellular and extracellular dehydration -body cells depleted -breakdown of fat and proteins for energy What are the 4 cardinal signs and symptoms of Diabetes Mellitus? 1. Polyuria 2. Polydipsia 3. Polyphagia 4. Weight loss 00:00 01:22 What are the 3 types of Diabetes Mellitus and how are each classified? 1. Type I Diabetes Mellitus (DM) -obtained at birth 2. Type II DM -obtained later in life 3. Gestational Diabetes Mellitus (GDM) -glucose intolerance of variable severity with onset or first recognition during pregnancy What are the profound changes in CHO, protein, and fat metabolism in pregnancy mediate by? 1. Developing fetus 2. Production of placental hormones How is glucose metabolism affected during the first half of pregnancy? Anabolic phase -increasing maternal hormones increase the demand for insulin production to facilitate increased storage of glycogen in maternal tissue How is glucose metabolism affected during the second half of pregnancy? Catabolic phase -hPl from the placenta causes resistance to the action of maternal insulin -this increases circulating glucose for fetal use and increases demand on the maternal pancreas to produce more insulin -leads to altered CHO metbolism and progressive hyperglycemia (in those who can't meet increasing demands of insulin production) -ketones in urine as a result of lipolysis What is the influence of pregnancy on diabetes? 1. Physiologic changes of pregnancy alter insulin requirements 2. Accelerates progress of vascular disease 3. More difficult to control pregnancy 4. Primary concern is control of blood glucose levels (IMPORTANT) Why are we concerned more with Type I diabetics when it comes to pregnancy? Uncontrolled Diabetes Mellitus can affect small vessels -placenta is full of small vessels -leads to high risk pregnancy if not controlled If the mother has hyperglycemia, how does the fetus respond? The fetus develops hyperglycemia as well -fetus produces its own insulin to treat its hyperglycemia -fetus's insulin can't help the mother's hyperglycemia because it can't cross the placental barrier (molecule is too big) What are the maternal risks of Diabetes Mellitus with pregnancy? 1. Hydramnios (too much amniotic fluid) 2. Preeclampsia-eclampsia 3. Hyperglycemia and ketoacidosis 4. Dystocia (difficult labor and delivery) 5. Increased susceptibility to infections 6. Worsening retinopathy 7. Spontaneous abortions 8. Preterm labor What are the fetal-neonatal risks of Diabetes Mellitus with pregnancy? 1. Perinatal mortality 2. Congenital abnormalities 3. Macrosomia (large baby) 4. IUGR (Intrauterine Growth Restriction = small baby) -usually with Type I mothers 5. Respiratory Distress Syndrome (RDS) 6. Polycythemia 7. Hyperbilirubinemia, Hypocacemia (from polycythemia) What is Gestational Diabetes Mellitus (GDM)? A type of DM characterized by an abnormal glucose tolerance test (GTT) and elevated fasting glucose that must be controlled by insulin -oral hypoglycemia meds are contraindicated during pregnancy due to adverse effects on the fetus