1. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture 3
Complication during pregnancy and its nursing management:
- D.M.

2. Diabetes and pregnancy
Outline
Normal metabolism in pregnancy
Pre existing diabetes and pregnancy
Gestational diabetes
Antenatal management
Postnatal follow up
Diabetes during pregnancy requires a multidisciplinary approach.
This session is an introduction to pre-existing type 1, type 2 and pregnancy, and gestational diabetes.

3. Normal metabolism in pregnancy
Increased fat metabolism
Increased ketone production
Decreased glucose production in the liver

4. Normal fetal metabolism
Fetal pancreas develops between 4 and 6 weeks after conception.
Insulin is produced at weeks.
Fetus obtains glucose via the placenta and can not produce its own glucose supply even during maternal hypoglycaemia.
3rd trimester glycogen storage in the liver and triglyceride production increases.

5. Type 1 diabetes and pregnancy
Preconception normoglycaemia (normal blood glucose level) is important.
Peri-natal mortality (death in the womb) is 2 and 3%.
Insulin requirements initially fall, then increase by 2nd and 3rd trimester.
Will need intensive insulin therapy and close monitoring.
Gestational diabetes characterized by an abnormal glucose tolerance test-GTT-and elevated fasting glucose.

6. Type 2 diabetes in pregnancy
Pre conception normoglycaemia is important.
If on oral medication, may need to switch to insulin.
Controlled with diet and exercise.
Gestational diabetes characterized by an abnormal glucose tolerance test-GTT-without other symptoms. Fasting glucose is normal.
Chan A, Scott J, Nguyen A & Keane R (2005) Pregnancy outcomes in South Australia, Pregnancy Outcomes Unit, Epidemiology Branch, Dept Human Services, Adelaide

7. Risks To mother: Hypoglycaemia Ketoacidosis (type 1 only) Retinopathy
Nephropathy
Pre eclampsia
Urinary tract infections

8. Risks To baby: Congenial abnormalities Macrosomia Spontaneous abortion
Intrauterine growth retardation
Fetal death in uterus

9. Post natal Risks to baby: Risks to mother: Prematurity
Respiratory distress
Birth trauma
Hypoglycaemia
Risks to mother:
Hypoglycaemia (if on insulin therapy)

10. Gestational diabetes (GDM)
Risk factors:
Family history of diabetes
GDM in previous pregnancy
Older maternal age (over 30 yrs)
Previous large babies (over 4kgs)
Obesity
High risk ethnic groups (eg South East Asian)
Complicated obstetric history
Chan A, Scott J, Nguyen A & Keane R (2005) Pregnancy outcomes in South Australia, Pregnancy Outcomes Unit, Epidemiology Branch, Dept Human Services, Adelaide

11. Antenatal management
Management aims are the same for type1, type 2 and gestational.
Aim is to maintain BGL’s between 3.5 and 7.0 mmol/L.
Regular home blood glucose monitoring
Dietary education.
Daily activity recommended.
Review by the obstetric physician, diabetes educator and dietitian.

12. Postnatal management gestational diabetes
Stop insulin as soon as baby is delivered.
Recommence normal diet as tolerated.
Regular home blood glucose monitoring
Screening prior to planning next pregnancy.
GDM Working Party (1999) Based on Hoffman L, Nolan C, Wilson JD, Oats JJ, Simons D, (1998), Gestational diabetes mellitus management guidelines, The Australiasian Diabetes in Pegnancy Ssociety, Med J Aust 169:93-97