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Introduction
  • Onset of insulin resistance during pregnancy
    • mediated by placental release of human placental lactogen (HPL), cortisol, and progesterone
  • Pathophysiology of hyperglycemia/insulinemia on the fetus
    • macrosomia
      • adiposity
      • insulin functions as a growth hormone
    • respiratory distress syndrome
      • insulin decreases production of surfactant
    • post-partum neonatal hypoglycemia  
      • high insulin levels in absence of high maternal glucose results in rapid drop in newborn blood glucose
Evaluation
  • Gestational diabetes screen 
    • between 24-28 weeks gestation
    • postive test if > 140 mg/dL 1 hour post-glucose challenge
    • follow up with confirmatory 3 hour glucose challenge
Treatment
  • Pharmacologic 
    • insulin in mothers with poor glycemic control
Prognosis, Prevention, and Complications
  • ↑ risk of GDM in future pregnancies, as well as type II diabetes
  • ↑ risk of neural tube defects, macrosomia, caudal regression syndrome in infant
 

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