Question

Caroline is 28 years old. She entered pregnancy with a BMI of 29.7 kg/m2. Caroline is half Hispanic, half African American. She has been gaining consistent weight. At 32 weeks she has gained 20 pounds. Her lab results came back from her oral glucose tolerance test (OGTT) and the results are below:

10 h fasting: 100 mg/dL

1 h post glucose 194 mg/dL

2 h post glucose: 161 mg/dL

Caroline’s health care provider suggested that she avoid sugar and high carbohydrate foods and to reduce her weight gain for the rest of her pregnancy.

1. Do you agree with her health care provider recommendations at 32 weeks after reviewing labs? Why or why not?

2. Was she insulin resistant? Why or Why not? – Explain your answer

Answer 1

Caroline is 28 years old, and her pre-pregnant BMI is 29.7 kg/m2 .

She falls under the overweight category. The recommended weight gain during pregnancy for this patient is 7 to 11 kg

she gained 20 pounds of weight. This means 20 * 0.45 kg = 9 kg .

, So the amount of weight gained is within normal limits .

fasting sugar is 100 mg /dl (normal range is below 100 mg/dl) , so here the value is high,

post 1 hr glucose value 194 mg /dl (normaly below 180 mg/dl), so here the value is high and abnormal

post 2 hr glucose level is 161 mg/dl (normaly below 140 mg/dl ) , so this value also high and abnormal .

normaly insuline hormone helps to reduce blood sugar level in blood by allowing entry of sugar into the cells .

Normaly in late parts of pregnancy , action of insuline hormone will be resisted  by other hormones increased during pregnancy like Estrogen , Lactogen , Human placental lactogen ..

So these will leads to insuline resistance and increased blood sugar level .

The patient is already overweight , and if she eat uncontrolled sugar and carbohydrates ,it increases uncontrolled sugar level and  it will adversily affect her pregnancy by causing so much complications in late stages of pregnancy like still birth , macrosomia , cesarian delivery , postpartum hemorhage , infections ...

So it is better to follow her health care advise to reduce body weight and avoiding sugar and carbohydrate ,

excersise allowed during pregnancy can be done , as this will reduce body weight as well as reduce blood sugar level by allowing more sugar to enter inside cell without the need of insuline .