[IL-CNM:850] forwarded form Nancy (Kolember) Westvan

Rosemary Meganck rmeganc at wpo.it.luc.edu
Tue Mar 28 14:23:24 CST 2000


Hi everyone!

I went to a conference here in Seattle last month and sat next to a
licensed midwife that does home deliveries.  She told me that she
always uses the jelly beans, that yes, they have to be Brach's; the
patient is instructed to fast x 3 hours, then eat the 18 Brach's jelly
beans in 2 minutes.  The blood sugar is checked in 1 hour and the
cut-off for normal is 120.  We had an excellent presentation on PP
screening for women with GDM; the recommendation is to evaluate
glucose tolerance with a 75 gram glucose
tolerance test 6-12 weeks PP.  The plasma glucose is measured fasting
and at 2 hours.  The interpretation is:

Normal:  FBS <110 AND 2-hr postload value <140

IGT: FBS 110-125 (impaired fasting glucose)
         2-hr postload >140 and < 200 (impaired glucose tolerance)

Diabetes:  FBS >125 OR
	     2-hr postload 200 or greater


Antepartum predictors for future type 2 diabetes:
1.  75% of women with FBS of >130 will develop DM (vs. 10% with     
FBS <105)
2.  Diagnosis of GDM prior to 24 weeks greatly increases the risk
3.  Impaired glucose tolerance during early PP - for those that fall  
   in the "IGT" range, 80%     will develop type 2 diabetes within    
 FIVE years - need to stress screening for these women
4.  Parity - a single pregnancy after GDM more than TRIPLES risk     
of developing type 2 diabetes in her lifetime (important for     
contraceptive counseling/family planning)
5.  pp weight at 6 weeks;  for every 10 pounds that she GAINS     
from her PP weight, this almost doubles her risk of      developing
type 2 diabetes; for every 10 pounds LOST, the risk      is almost
halved (also important for counseling)

anyway, just some interesting FYI facts; Springtime in WA is beautiful
:))

Nancy




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