1. Emily Spencer, Melissa Warren, Quang Pham and Sherita Green

2.  Diabetes rates are increasing for women in the reproductive years (18-44)  From 1990-1998 rates increased 70% for women aged 30-39 years old  About 8.1 million women in American have diabetes  Between about 2-7% of expectant mothers develop gestational diabetes

3.  A strong presence of diabetes in our country places added demands on the healthcare delivery system  Children exposed to diabetes in the womb have a greater likelihood of becoming obese during childhood and adolescence and for developing type II diabetes later in life

4.  It is important to educate women with type I or II diabetes on what they can do to have a healthy baby (get diabetes under control 3-6 months before trying to get pregnant; if pregnant, see healthcare provider; diet; etc.)

5.  Although expectant mother with diabetes can and do have normal healthy pregnancies and deliveries, they are at greater risk for complications such as preeclampsia, cesarean section, and infections

6.  Gestational diabetes usually ends after baby is born, but women with gestational diabetes have up to a 45% risk of recurrence with the next pregnancy and up to a 63% risk of developing type 2 later in life – this leads to future health implications

7.  Insulin produced by beta cells in the pancreas lowers blood glucose levels by enabling glucose to move into muscle and liver cells where it is stored as glycogen.  Falling blood glucose levels stimulate pancreas to release glucagon

8.  Glucagon stimulates breakdown of glycogen stores into glucose which returns to the blood stream  In DM, pancreas does not produce enough insulin to allow proper carbohydrate metabolism  Without proper amounts of insulin glucose cannot enter cells for storage and stays in blood

9.  Type I DM - destruction of beta cells leading to absolute insulin deficiency  Type II DM- combination of insulin secretion defect, and insulin resistance

10.  Carbohydrate intolerance with variable severity with onset or first recognition during pregnancy  As gestation progresses blood glucose levels increase as insulin sensitivity decreases

11.  For maintenance of glucose control during pregnancy maternal insulin secretion must increase enough to counteract the fall in sensitivity  GDM occurs when there is not enough insulin to counteract the pregnancy related decrease in insulin sensitivity.

12.  Emphasize importance of prenatal healthcare  Educate about warning signs like excessive weight gain, eating healthy and exercising throughout pregnancy  Educate about signs and symptoms of hyperglycemia  Make sure woman and possibly family members know how to check blood sugar levels

13.  Age (35 years or older)  Previous infant that was LGA (4000 g)  Unexplained fetal demise  History of gestational diabetes  Family history of type II or gestational diabetes  Obesity (90 kg or greater)  Fasting glucose of 140 mg/dL or a random glucose of 200 mg/dL

14.  Polyuria, Polydispsia and Polyphagia  Unexplained weight loss  Numbness and tingling in hands and feet  Fatigue  Sudden vision changes  Dry skin  Slow healing wounds  Increased infections

15.  Eat 3 regular meals with 3 snacks during the day. Avoid large meals.  Carbohydrates should not account for more than 50% with protein and fat equally accounting for the remainder.  If obese, a 33% calorie restriction is advised.

16.  Insulin therapy such as lispro, regular, and NPH can be used safely during pregnancy.  Adjustments to short-acting insulin may be needed as pregnancy progresses due to glucose surges.  Insulin pumps can also be used throughout pregnancy safely and effectively.  Hypoglycemic agents such as Glyburide and Metformin can be used.

17.  Encourage pregnant women to follow prenatal check-ups regularly.  Teach pregnant women about risk factors of gestational diabetes such as African, obesity, family history of diabetes, > 25 years of age

18.  Teach pregnant women about gestational diabetes’ symptoms such as blurred vision, fatigue, frequent infection, increased thirst, increased urination, nausea and vomiting  Teach pregnant women how to use glucose meter and self monitoring of blood glucose levels

19.  Have oral glucose tolerance test at 24 th and 28 th week  Have a nonstress test during pregnancy for monitoring fetal well being  Have ultrasound exams to monitor fetal gestational age and fetal growth

20.  Manage diet and food consumptions such as calories, nutrient to control blood glucose  Avoid eating high glucose foods and eat variety of healthy foods  Take prenatal vitamin supplements

21.  Follow regular exercise routines such as walking at least 3 times per week  Insulin therapy, if necessary  Monitor weight gain

22.  Davidson, M. London, M., & Ladewig, P. (2008). Old’s Maternal-Newborn Nursing & Women’s Health Across the Lifespan (8th ed.) Upper Saddie River: Pearson Prentice Hall. (p. 450-460)  http://www.cdc.gov http://www.cdc.gov  Diabetes Mellitus. University of California, San Francisco. Retrieved http://www.ucsfhealth.org/adult/medical_services/hormone/diabetes/conditions/diabete s/signs.html  Diabetes Mellitus and pregnancy. Emedicine. Retrieved http://emedicine.medscape.com/article/127547-overview  http://www.nlm.nih.gov/medlineplus/ency/article/000896.htm http://www.nlm.nih.gov/medlineplus/ency/article/000896.htm