peer response of pregnancy

Hello Stacey,

I find your description of obstetric history to be correct – G6T3P0A2L3. Also, glucose tolerance tests qualify diagnosis for gestational diabetes mellitus (GDM). Practitioners must be keen on making the correct diagnosis since we have learned from the text that glycosuria tends to increase during pregnancy. The Institute for Quality and Efficiency in Health Care (2017) guides that a glucose tolerance test is normal if the reading is 135 mg/dL or less after one hour, and a 2-hour glucose tolerance test is 153mg/dL or less. In this case, the patient’s serum glucose greater than 140mg/dL for fasting and greater than 155 mg/dL at two hours confirms GDM (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). I agree with your suggested differential diagnosis since a test for diabetes mellitus during pregnancy is often overlooked. In addition to your identified risk factors, having a BMI >30 escalates the chances for diagnosis for gestational diabetes mellitus. I think that your treatment plan is complemented, and I would choose it too. First, non-pharmacological interventions include dietary modifications and exercise to reduce the risks of side effects of drugs. However, you would have to be cautious to maintain her body BMI according to pre-pregnancy weight (Tobah, 2020). In line with medications, insulin and metformin are ideal choices.

References

Institute for Quality and Efficiency in Health Care (2017). How is gestational diabetes diagnosed? InformedHealth.Org. https://www.ncbi.nlm.nih.gov/books/NBK441573/ (Links to an external site.).

National Institute of Diabetes and Digestive and Kidney Diseases. (2017). “Test & Diagnosis for Gestational Diabetes”. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational/tests-diagnosis#:~:text=Doctors%20use%20blood%20tests%20to,to%20check%20for%20gestational%20diabetes (Links to an external site.).

Tobah, Y. (2020). Why is weight loss before pregnancy important?. Mayo Clinic. Retrieved 2 November 2020, from https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/expert-answers/weight-loss-before-pregnancy/faq-20380882#:~:text=Achieving%20a%20healthy%20pre%2Dpregnancy,in%20vitro%20fertilization%20(IVF).

Hello Christy,

I am pleased by how you organized the post. I also think the obstetric history’s best description is G6T3P0A2L3 since the number of full-term deliveries is relevant. Otherwise, I agree with your diagnosis. One might be tempted to diagnose advanced maternal age since she is past 35, but the glucose tolerance tests confirm gestational diabetes mellitus (GDM). The major criterion for this diagnosis is that the patient has a glucose tolerance test that is higher than 135 mg/dL and a 2-hour glucose tolerance test that is higher than 153 mg/dL (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). Thank you for highlighting the reason why pre-existing diabetes is a critical differential diagnosis. The risk factors have previously been identified by Pons et al. (2015) to be more than 25 old, obesity, previous diagnosis of GDM, history of hypertension, history of prediabetes, are of a certain ethnic background especially South Asian descent, and family history of diabetes. Lastly, I would categorize your treatment plan into pharmacological, non-pharmacological, or a mixed approach treatment plan. I would add to your plan that metformin may be considered an alternative where the patient cannot take insulin or prefers not to take insulin.

References

National Institute of Diabetes and Digestive and Kidney Diseases. (2017). “Test & Diagnosis for Gestational Diabetes”. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational/tests-diagnosis#:~:text=Doctors%20use%20blood%20tests%20to,to%20check%20for%20gestational%20diabetes (Links to an external site.).

Pons, R.S., Rockett, F.C., Rubin, B.A., Opperman, M.L.R., & Bosa, V.L.(2015). Risk factors for gestational diabetes mellitus in a sample of pregnant women diagnosed with the disease. Diabetology & Metabolic Syndrome, 7(1), A80. https://dx.doi.org/10.1186%2F1758-5996-7-S1-A80 (Links to an external site.)