1. Gestational Diabetes
Lab 4

2. Diabetes Mellitus: definition
Complex disorder of carbohydrate metabolism Caused by a partial or complete lack of insulin secretion by the beta cells of the pancreas.
Without insulin, glucose accumulates in the blood (hyperglycemia)
Classic symptoms of diabetes
Polydipsia
Polyuria
Polyphagia
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

3. Diabetes Mellitus: Effect of Pregnancy on Fuel Metabolism
Early pregnancy
Small change in maternal metabolic need
Insulin release in response to serum glucose levels accelerates.
May experience hypoglycemia
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4. Diabetes Mellitus: Effect of Pregnancy on Fuel Metabolism (Cont.)
Late pregnancy
Fetal growth accelerates
Rise in placental hormone levels
Hormones create resistance to insulin.
Birth
Maintenance of normal maternal glucose levels is essential during birth to reduce neonatal hypoglycemia.
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

5. Diabetes Mellitus: Effect of Pregnancy on Fuel Metabolism (Cont.)
Postpartum
The need for additional insulin falls.
Breastfeeding is encouraged.
The added calorie intake by the mother helps lower the amount of insulin needed in women with types 1 and 2 diabetes mellitus.
The woman with gestational diabetes mellitus (GDM) usually needs no insulin after birth.
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

6. Diabetes Mellitus: Classification
Type 1
Insulin deficient
Type 2
Insulin resistant
GDM
The onset of glucose intolerance during pregnancy
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

7. Diabetes Mellitus: Incidence
Diabetes mellitus is a common medical condition.
About 90% to 95% of diagnoses are type 2.
Type 1 accounts for 5% to 10% of diagnoses.
Up to 10% of all pregnancies are affected by GDM.
Women who have GDM in pregnancy have a 35% to 60% chance of developing diabetes in the next 10 to 20 years.
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

8. Diabetes Mellitus: Preexisting
Maternal effects
During first trimester
Hypoglycemia, hyperglycemia, ketosis
Increased incidence of spontaneous abortion or major fetal malformations
Preeclampsia is two to three times more likely to develop.
Premature rupture of the membranes (PROM)
Macrosomia
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

9. Diabetes Mellitus: Preexisting (Cont.)
Fetal effects
Congenital malformation
Variations in fetal size
Small for gestational age (SGA)
Intrauterine growth restriction (IUGR)
Large for gestational age (LGA)
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

10. Diabetes Mellitus: Preexisting (Cont.)
Neonatal effects
Hypoglycemia
Hyperbilirubinemia
Respiratory distress syndrome
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

11. Macrosomia
Glucose can cross the placenta. The Maternal hyperglycemia can cause the fetal hyperglycemia. The hyperglycemia would stimulate the growth of fetus, then macrosomia will occur.

12. Hypoglycemia
The fetus produces its own insulin to modulate its blood glucose. The hyperinsulinemia will occur in response to the hyperglycemia in the fetus. After delivery, the blood glucose provided by mother will be stopped, but the insulin production would not be reduced, so the hypoglycemia will results in the newborn.

13. Diabetes Mellitus: Maternal Assessment
History
Onset and management of diabetic condition
May need insulin to control (no oral agent)
Physical exam
Baseline electrocardiogram (ECG)
Ophthalmology referral
Height, weight, and blood pressure (BP)
Laboratory tests
24 hour urine
Hemoglobin A1c (HbA1c)
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

14. Diabetes Mellitus: Fetal Surveillance
Surveillance should begin early for women with preexisting diabetes.
Testing for anomalies
Frequent ultrasound
Fetal echocardiogram
Fetal kick count
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

15. Diabetes Mellitus: Therapeutic Management
Maintain normal blood glucose levels.
Facilitate the birth of a healthy baby.
Avoid accelerated impairment of blood vessels and other major organs.
Preconception care
Diet
Self-monitoring of glucose
Insulin therapy
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

16. Gestational Diabetes Mellitus: Risk Factors
Overweight
Maternal age older than 25 years
Previous birth outcome often associated with GDM
GDM in previous pregnancy
History of abnormal glucose tolerance
Family history of diabetes
Member of a high-risk ethnic group
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

17. Gestational Diabetes Mellitus: Screening
Glucose challenge test
1 hour test, 50g of oral glucose solution
If abnormal: 3 hour oral glucose tolerance test (OGTT) 100g of glucose solution
Oral glucose challenge test
Fasting, greater than 95 mg/dL
1 hour, greater than 180 mg/dL
2 hours, greater than 155 mg/dL
3 hours, greater than 140 mg/dL
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

18. Gestational Diabetes Mellitus: Therapeutic Management
Diet
Registered dietitian, registered dietary technician, or diabetes educator
Nonobese prepregnancy weight, an average of 30 kcal/kg/day is recommended
Obese: 25 kcal/kg/day
Exercise
Blood glucose monitoring
Fetal surveillance
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

19. Gestational Diabetes Mellitus: Nursing Considerations
Increase effective communication.
Provide opportunities for control.
Provide normal pregnancy care.
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

20. Application of the Nursing Process: Pregnant Woman with Diabetes
Assessment
History
Onset and management of diabetic condition
May need insulin to control (no oral agent)
Physical exam
Baseline ECG
Ophthalmology referral
Height, weight, and BP
Laboratory tests
24 hour urine
HbA1c
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

21. Application of the Nursing Process: Pregnant Woman with Diabetes (Cont
Intervention
Teaching self-care skills
Home blood glucose monitoring
Insulin administration
Continuous subcutaneous insulin infusion
Teaching dietary management
Recognizing and correcting hypoglycemia and hyperglycemia
Explaining procedures, tests, and plan of care
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

22. Reference
“Foundations of Maternal-Newborn and Women's Health Nursing” by Sharon Murray, Emily McKinney, 6th Edition; Saunders