NSPN 7200: Chapter 6+7 Exam Questions With
Complete Answers
PERCENTAGE OF PREGNANT WOMEN THAT DEVELOP GD IN CANADA - ANSWER
3-20%
DEFINE PRE-GESTATIONAL DIABETES MELLITUS (PGDM) - ANSWER Pre-existing
diabetes
WHAT PERCENTAGE OF PREGNANT PEOPLE WITH DM WILL HAVE PGDM - ANSWER
10%
NAME THE RISK FACTOS/COMPLICATIONS OF PGDM - ANSWER - miscarriage **
- Fetal congenital malformation during orgnaogeneisis**
-Stillbirth**
- HTN, preeclampsia, macrosomia, preterm birth, c/s, neonatal/perinatal morbidities and
mortalities
After birth: hypoglycemia, jaundice, RDs, infant feeding
WHAT ARE THE MEDICAL APPROACHES TO CARE FOR PGDM? - ANSWER
-Pre-conceptions counselling**
- Appropriate glycemic control** (hgb A1c)
- Pharmacologic therapy
- Planned early delivery (between 38-40 weeks)
DEFINE GESTATIONAL DIABETES MELLITUS - ANSWER glucose intolerance of variable
degree that begins or is first detected during pregnancy (usually 2nd trimester)
,DESCRIBE THE RISK FACTORS/ COMPLICATIONS OF GDM - ANSWER ** No increased
risk of congenital malformation
- Miscarriage not really an issue (no organogenesis)
-HTN, preeclampsia, preterm birth, c/s, macrosomia, stillbirth, neonatal/perinatal
morbidities and mortalities
WHAT MEDICAL APPROACHES TO CARE DO YOU EXPECT FOR GDM - ANSWER
**Screening at 24-28 weeks
- Preferred approach: 50g glucose challenge test
Self-monitoring and management:
- Diet and exercise (if diagnosed) for two weeks--> if unmanaged then insulin
EXPLAIN THE DIFFERENCE BETWEEN THE PREFERRED APPROACH GLUCOSE
CHALLENGE VS. THE ALTERNATIVE APPROACH - ANSWER Preferred
- 50 grams
- more selective of dx
- Will use 75 grams after if further testing is needed
Alternative
- 75 grams
- Higher chance of "over-diagnosing"
Define Diabetogenic? - ANSWER Hormones are secreted to cause high levels of glucose
in mom for baby and insulin resistance to ensure maternal sources are not used up.
IDENTIFY THE RISK FACTORS FOR DEVELOPING GDM - ANSWER - overweight/obesity
- family history of DM
- PCOS
- previous diagnosis of GDM
, - HTN
- High-risk populations: Hispanic, African-American, Indigenous
- Age over 25
- previous macrosomic infants
IDENTIFY THE SIGNS AND SYMPTOMS OF GESTATIONAL DIABETES - ANSWER -
Usually asymptomatic
- Otherwise: polyphagia, polydipsia, polyuria, tingling limbs, blurry vision, fatigue, sugar
in urine
AT WHAT WEEKS DO WE CONSIDER INDUCTION FOR PGDM ? - ANSWER - induction at
38-40 weeks
- IDGDM: 39 weeks
-Aimed at reducing the risk of stillbirths and macrosomia
IS IA OR EFM USED FOR PGDM AND GDM - ANSWER EFM
DURING LABOUR WHAT IS THE GOAL BLOOD SUGAR TO MAINTAIN MOM? WHY IS
THIS IMPORTANT? - ANSWER - Between 4.0-7.0 (but check policy)
-Important as high blood sugars will stimulate the infant to produce insulin--> once
delivered no more sugar stores from the placenta and may go hypoglycemic with too
much insulin
WHAT INTRAPARTUM CONSIDERATIONS WOULD YOU MAKE FOR SOMEONE WITH DM
IN LABOUR? - ANSWER Checking CBGs: early labour q2h and active labour q1h
IV if NPO: NS and D5W (check policy)
Check urine for ketones with each void during labour- monitor I+Os
Complete Answers
PERCENTAGE OF PREGNANT WOMEN THAT DEVELOP GD IN CANADA - ANSWER
3-20%
DEFINE PRE-GESTATIONAL DIABETES MELLITUS (PGDM) - ANSWER Pre-existing
diabetes
WHAT PERCENTAGE OF PREGNANT PEOPLE WITH DM WILL HAVE PGDM - ANSWER
10%
NAME THE RISK FACTOS/COMPLICATIONS OF PGDM - ANSWER - miscarriage **
- Fetal congenital malformation during orgnaogeneisis**
-Stillbirth**
- HTN, preeclampsia, macrosomia, preterm birth, c/s, neonatal/perinatal morbidities and
mortalities
After birth: hypoglycemia, jaundice, RDs, infant feeding
WHAT ARE THE MEDICAL APPROACHES TO CARE FOR PGDM? - ANSWER
-Pre-conceptions counselling**
- Appropriate glycemic control** (hgb A1c)
- Pharmacologic therapy
- Planned early delivery (between 38-40 weeks)
DEFINE GESTATIONAL DIABETES MELLITUS - ANSWER glucose intolerance of variable
degree that begins or is first detected during pregnancy (usually 2nd trimester)
,DESCRIBE THE RISK FACTORS/ COMPLICATIONS OF GDM - ANSWER ** No increased
risk of congenital malformation
- Miscarriage not really an issue (no organogenesis)
-HTN, preeclampsia, preterm birth, c/s, macrosomia, stillbirth, neonatal/perinatal
morbidities and mortalities
WHAT MEDICAL APPROACHES TO CARE DO YOU EXPECT FOR GDM - ANSWER
**Screening at 24-28 weeks
- Preferred approach: 50g glucose challenge test
Self-monitoring and management:
- Diet and exercise (if diagnosed) for two weeks--> if unmanaged then insulin
EXPLAIN THE DIFFERENCE BETWEEN THE PREFERRED APPROACH GLUCOSE
CHALLENGE VS. THE ALTERNATIVE APPROACH - ANSWER Preferred
- 50 grams
- more selective of dx
- Will use 75 grams after if further testing is needed
Alternative
- 75 grams
- Higher chance of "over-diagnosing"
Define Diabetogenic? - ANSWER Hormones are secreted to cause high levels of glucose
in mom for baby and insulin resistance to ensure maternal sources are not used up.
IDENTIFY THE RISK FACTORS FOR DEVELOPING GDM - ANSWER - overweight/obesity
- family history of DM
- PCOS
- previous diagnosis of GDM
, - HTN
- High-risk populations: Hispanic, African-American, Indigenous
- Age over 25
- previous macrosomic infants
IDENTIFY THE SIGNS AND SYMPTOMS OF GESTATIONAL DIABETES - ANSWER -
Usually asymptomatic
- Otherwise: polyphagia, polydipsia, polyuria, tingling limbs, blurry vision, fatigue, sugar
in urine
AT WHAT WEEKS DO WE CONSIDER INDUCTION FOR PGDM ? - ANSWER - induction at
38-40 weeks
- IDGDM: 39 weeks
-Aimed at reducing the risk of stillbirths and macrosomia
IS IA OR EFM USED FOR PGDM AND GDM - ANSWER EFM
DURING LABOUR WHAT IS THE GOAL BLOOD SUGAR TO MAINTAIN MOM? WHY IS
THIS IMPORTANT? - ANSWER - Between 4.0-7.0 (but check policy)
-Important as high blood sugars will stimulate the infant to produce insulin--> once
delivered no more sugar stores from the placenta and may go hypoglycemic with too
much insulin
WHAT INTRAPARTUM CONSIDERATIONS WOULD YOU MAKE FOR SOMEONE WITH DM
IN LABOUR? - ANSWER Checking CBGs: early labour q2h and active labour q1h
IV if NPO: NS and D5W (check policy)
Check urine for ketones with each void during labour- monitor I+Os
