Pharmacological and Parenteral Therapies Q 14
A client with diabetes visits the prenatal clinic at 28 weeks gestation. Which statement is true regarding insulin needs during pregnancy?
A. Insulin requirements moderate as the pregnancy progresses.
B. A decreased need for insulin occurs during the second trimester.
C. Elevations in human chorionic gonadotropin decrease the need for insulin.
D. Fetal development depends on adequate insulin regulation.
Correct Answer: D. Fetal development depends on adequate insulin regulation.
Fetal development depends on adequate nutrition and insulin regulation. Significant alterations in maternal metabolism during pregnancy ensure a continuous supply of nutrients to the fetus. Glucose is the primary energy source for the fetus. In early pregnancy, increases in maternal insulin sensitivity enable the storage of energy and nutrients.
Option A: Insulin requirements do not moderate as the pregnancy progresses. To counteract insulin resistance and achieve adequate metabolic control in late pregnancy, the dose of insulin may need to be increased. Understanding insulin requirements in pregnant women with type 1 diabetes would help them to maintain tight glycemic control.
Option B: Insulin needs to increase during the second and third trimesters. In late pregnancy, maternal insulin resistance develops due to increases in pregnancy-related hormones, such as progesterone, human placental lactogen and prolactin, as well as inflammatory cytokines, such as tumor necrosis factor-?. These changes facilitate the supply of glucose toward the fetus.
Option C: Elevated human chorionic gonadotropin elevates insulin needs, not decreases them. Insulin dose prior to pregnancy was associated with pre-pregnancy body weight, BMI, and HbA1c levels before pregnancy and in the first trimester. Insulin dose prior to pregnancy was higher in patients with male infants than patients with female infants.