RH Case 11 Sugar MommaDAY 1-Placental Lactogen (hCS) contributes to insulin resistance, and downregulation of insulin receptor (internalization); human placental growth hormone also does this.-TNFalpha is the strongest independent predictor of insulin sensitivity in pregnancy. It is made by adipocytes, as well as IL-6, adiponectin, and resistin.-Maternal insulin doesn't cross the placenta because it is too big. There is a direct relationship between maternal glucose and fetal glucose.-Hyperglycemia-->hyperinsulinemia in fetus. Diabetic women are at increased risk for: preeclampsia, hypertension, ketoacidosis, neuropathy.-Poorly controlled Type 1 Diabetes can lead to congenital malformations and/or miscarriage: neural tube defects, transposition of great arteries (overriding aorta),sacral agenesis, Type 2 Diabetes, respiratory distress syndrome (RDS), jaundice.-GLUT1 is main glucose transporter of the placenta. Fetal liver: GLUT2. Fetal muscle: GLUT4. Fetal kidney: GLUT2. Fetal lung: GLUT1. Fetal brain: GLUT1,2.-Hyperglycemia can lead to p53 activation-->cell death. This may involve decreased levels of GLUT1. May also involve oxidative stress, inhibiting PAX3.DAY 2-Intrauterine Growth Restriction (IUGR): decreased perfusion across the placenta. Asymmetrical IUGR is preventable. Symmetrical IUGR: decreased potential to grow(genetics, infection: TORCH for Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex)-Macrosomia: big baby, above 4000-4500 grams. Happens as a result of hyperglycemia leading to hyperinsulinemia. Excess insulin acts as fetal growth hormone onInsulin-like growth hormone receptors.-Diabetic Ketoacidosis: extreme hyperglycemia, dehydration (volume depletion + electrolyte imbalance), metabolic acidosis (respiratory compensation by hypervent.)Causes: not taking insulin, not eating, unregulated alcohol consumption, infections (UTI, GI).-Baby can be born with reflex hypoglycemia due to hyperinsulinemia. Therefore, must monitor and administer glucose+insulin appropriately.Hyperinsulinemia-->RBCs can't carry O2 well-->increased RBCs-->increased bilirubin-->jaundice-Nifedipine: inhibits Ca++ influx into vascular smooth muscle and myocardium. It is a tocolytic.-Betamethasone: Increases surfactant production in lungs. It is a corticosteroid/glucocorticoid.