Gestational Gestational This webcast is made possible by the - PDF document

Acknow ledgm ents Acknow ledgm ents Gestational Gestational This webcast is made possible by the support of the Colorado Diabetes Prevention and Control Program (CDPCP), which is working to improve access to quality care for women with Gestational Diabetes in Colorado. The CDPCP is supported by Diabetes Diabetes Cooperative Agreement U32/CCU800342-21-02 from the Centers for Disease Control and Prevention. PUTTING GUIDELINES PUTTING GUIDELINES Co-Sponsored By: INTO PRACTICE INTO PRACTICE February 13 th , 2009 Web page: www.diabetesedu.org Web page: http://www.cdphe.state.co.us/pp/diabetes/index.html Presenters Presenters Objectives Objectives � Recognize risk factors for GDM and discuss Recognize risk factors for GDM and discuss � Introduction by Michelle Hansen, RD, MS, CDE methods for preventing the development of methods for preventing the development of Director - Diabetes Prevention and Control Program GDM GDM Colorado Department of Public Health and Environment � Relate the Colorado Clinical Guidelines for Relate the Colorado Clinical Guidelines for � GDM to practice GDM to practice � Recognize client challenges and barriers to Recognize client challenges and barriers to � adequately care for GDM adequately care for GDM Presentation by Mandy McCulloch, RD � Identify educational tools and resources for Identify educational tools and resources for � Prenatal Program Director - Women’s Health available use with clients available use with clients Nutrition Consultant - Diabetes Prevention and Control Program � Discuss the long Discuss the long- - term risk of GDM in the term risk of GDM in the � development of type 2 diabetes for both development of type 2 diabetes for both Colorado Department of Public Health and Environment mother and child mother and child Definition of GDM Definition of GDM W hy Does I t Develop? W hy Does I t Develop? � Insulin transports glucose from blood into Insulin transports glucose from blood into � cells cells � Gestational Diabetes Mellitus (GDM) is Gestational Diabetes Mellitus (GDM) is � � Placental hormones and inflammatory Placental hormones and inflammatory � glucose intolerance recognized for the glucose intolerance recognized for the cytokines (TNF- - a) cause worsening insulin a) cause worsening insulin cytokines (TNF first time during pregnancy. first time during pregnancy. nd trimester resistance in the late 2 nd trimester – – resistance in the late 2 � This does not currently recognize the This does not currently recognize the � intended to shunt nutrients to the fetus intended to shunt nutrients to the fetus difference between pre- - existing existing difference between pre � Women are unable to produce enough Women are unable to produce enough � diabetes identified for the first time diabetes identified for the first time insulin to overcome the overwhelming insulin to overcome the overwhelming during pregnancy and diabetes that during pregnancy and diabetes that resistance and maintain euglycemia resistance and maintain euglycemia develops due to the pregnancy If body cannot keep up with ↑ ↑ demand � ↑ ↑ develops due to the pregnancy demand � � If body cannot keep up with � � G glucose in the blood � glucose in the blood Gestational estational Diabetes Diabetes 1

W hy Be Concerned? Risk Factors W hy Be Concerned? Risk Factors � Maternal Concerns Maternal Concerns � High High- - Risk if any of the following: Risk if any of the following: � � � Increased intensity of medical care Increased intensity of medical care � Advanced maternal age ( Advanced maternal age ( > > 35 y.o.) 35 y.o.) � � 2 based on PPW) � Obese (BMI > 29 kg/ m Obese (BMI > 29 kg/ m 2 based on PPW) � Higher risk of infections, C Higher risk of infections, C- - section section � � � High High- - risk ethnic population risk ethnic population � ~ 5 0 % Maternal risk of developing type 2 ~ 5 0 % Maternal risk of developing type 2 � � Diabetes in 5 - Diabetes in 5 - 10 years!! 10 years!! � Asian/ Pacific Islander, American Indian, Hispanic, Asian/ Pacific Islander, American Indian, Hispanic, � Black Black � Infant Concerns Infant Concerns � � Prior history of GDM Prior history of GDM � � Increased central obesity Increased central obesity � � Previous Previous macrosomic macrosomic infant infant � � Risk of stillbirth Risk of stillbirth � � Birth weight is > 4000g (8# 13oz.) Birth weight is > 4000g (8# 13oz.) � � Problems regulating glucose & may need NICU Problems regulating glucose & may need NICU � � History of GDM related obstetric complications History of GDM related obstetric complications � � Enlargement of pancreas, heart and liver Enlargement of pancreas, heart and liver � � First degree relative with diabetes First degree relative with diabetes � � ↑ ↑ risk for developing childhood obesity and risk for developing childhood obesity and � � Parent, sibling, child Parent, sibling, child � type 2 “ type 2 “adult onset adult onset ” ” diabetes diabetes � Polycystic Ovary Syndrom e (PCOS) Polycystic Ovary Syndrom e (PCOS) � � Glycosuria Glycosuria � * Slide adapted from Dr. Linda Barbour, 12.6.06 GDM Prevention GDM Prevention Colorado Clinical Colorado Clinical � Client is Client is “ “ High High- - Risk Risk” ” , what can you , what can you � Guidelines on Guidelines on do? do? � Early glucose screening Early glucose screening Gestational Gestational � � Educate on healthy eating & exercise Educate on healthy eating & exercise � Diabetes Diabetes � Track weight gain Track weight gain � � Tell her about the risk of GDM Tell her about the risk of GDM � Developed by the Colorado Clinical Guidelines Collaborative and the Diabetes Prevention and Control Program at the Colorado Department of Public Health and Environment November 2006 Early Screening Protocol Screening Protocol Early Universal Screening Universal Screening for High Risk W om en for High Risk W om en at 2 4 - at 2 4 - 2 8 w eeks 2 8 w eeks � Screen Screen all all women for GDM women for GDM � � 50 50- - g, 1 g, 1- - hour Oral Glucose Challenge Test hour Oral Glucose Challenge Test � between 24- - 28 weeks with a 28 weeks with a between 24 (OGCT) when risk factors are identified (OGCT) when risk factors are identified 50- 50 - gram, 1 gram, 1- - hour OGCT hour OGCT � If OGCT If OGCT > > 135 mg/ dl, follow with 3 135 mg/ dl, follow with 3- - hour hour � � If OGCT is < 135 mg/ dl, no If OGCT is < 135 mg/ dl, no Oral Glucose Tolerance Test (OGTT) Oral Glucose Tolerance Test (OGTT) � further testing required further testing required � If positive OGTT, there is suspicion of pre If positive OGTT, there is suspicion of pre- - � � During the last trimester insulin During the last trimester insulin � existing diabetes existing diabetes needs are 2- - 3x higher 3x higher needs are 2 � If 1 If 1- - hour OGCT < 135 mg/ dl or values on hour OGCT < 135 mg/ dl or values on � � Follow diagnostic criteria Follow diagnostic criteria 3- - hour OGTT are normal, then re hour OGTT are normal, then re- - screen screen � 3 between 24- between 24 - 28 weeks 28 weeks 2