Gestational Diabetes
Nursing Care Plan &
Management
Description
1. Gestational diabetes is abnormal carbohydrate, fat, and protein
metabolism that is first diagnosed during pregnancy, regardless
of the severity.
2. Gestational diabetes is further classified as:
▪ Gestational diabetes characterized by an abnormal glucose
tolerance test (GTT) without other symptoms. Fasting
glucose is normal and the diabetes is controlled by diet (A1).
▪ Gestational diabetes characterized by abnormal glucose
tolerance test and elevated fasting glucose. This type of
gestational diabetes must be controlled by insulin (A2).
3. About 15,000 infants are born to mothers with diabetes each
year. Since 1980, the International Workshop-Conference on
gestational Diabetes and the American Diabetic Association has
recommended universal screening for gestational diabetes
between 24 and 28 weeks of gestation.
Aetiology
,▪ Gestational diabetes is a disorder of late pregnancy (typically),
caused by the increased pancreatic stimulation associated with
pregnancy.
Pathophysiology
1. In gestational diabetes mellitus (type III, GDM), insulin
antagonism by placental hormones, human placental lactogen,
progesterone, cortisol, and prolactin leads to increased blood
glucose levels. The effect of these hormones peaks at about 26
weeks’ gestation. This is called the diabetogenic effect of
pregnancy.
2. The pancreatic beta cell functions are impaired in response to the
increased pancreatic stimulation and induced insulin resistance.
3. Pregnancy complicated by diabetes puts the mother at increased
risk for the development of complications, such as spontaneous
abortion, hypertensive disorders, and preterm labour, infection,
and birth complications.
4. The effects of diabetes on the foetus include hypoglycaemia,
hyperglycaemia, and ketoacidosis. Hyperglycaemic effects can
include:
a. Congenital defects
b. Macrosomia
c. Intrauterine growth restriction
d. Intrauterine fetal death
e. Delayed lung maturity
f. Neonatal hypoglycaemia
g. Neonatal hyperbilirubinemia
Assessment Findings
1. Associated findings include a poor obstetric history, including
spontaneous abortions, unexplained stillbirth, unexplained
hydramnios, premature birth, low birth weight or birth weight
exceeding 4,000 g (8lb, 13 oz), and birth of a new born with
congenital anomalies.
2. Common clinical manifestations include:
▪ Glycosuria on two successive office visits
▪ Recurrent monilial vaginitis
▪ Macrosomia of the foetus on ultrasound
▪ Polyhydramnios
, 3. Laboratory and diagnostic study findings.
▪ Fasting blood sugar test will reveal elevated blood glucose
levels.
▪ A 50-g glucose screen (blood glucose level is measured 1 hour
after client ingests a 50-g glucose drink) reveals elevated
blood glucose levels. The normal plasma threshold is 135 to
140 mg/dL.
▪ A 3- hour oral glucose tolerance test (performed if 50-g
glucose screen results are abnormal) reveals elevated blood
glucose levels. (Table 1)
▪ The glycosylated haemoglobin (Hiba 1c) test (measures
glycaemic control in the 4 to 8 weeks before the test is
performed; performed on women with pre-existing diabetes)
results reflect enzymatic bonding of glucose to haemoglobin
An amino acids. This is a useful indicator of overall blood
glucose control. The upper normal level of HbA1c is 6% of
total haemoglobin.
▪ Screens for fetal (and later, neonatal) complications, including:
6.
▪ Maternal serum alpha-fetoprotein level to assess risk for
neural tube defects in new born.
▪ Ultrasonography to detect fetal structural anomalies,
macrosomia, and hydramnios.
▪ Nonstress test (as early as 30 weeks), contraction stress
test, and biophysical profile because of risk of unexplained
intrauterine fetal demise in the antepartum period.
▪ Lung maturity studies (by amniocentesis) to determine
lecithin sphingomyelin (L/S) ratio and to detect
phosphatidylglycerol (PG); the adequacy of L/S and PG,
predictor of the new-born’s ability to avoid respiratory
distress
Risk For Maternal Injury
Risk for Injury: Vulnerable for injury as a result of environmental
conditions interacting with the individual’s adaptive and defensive
resources, which may compromise health.
Risk factors
▪ Altered immune response.
▪ Anaemia.
Nursing Care Plan &
Management
Description
1. Gestational diabetes is abnormal carbohydrate, fat, and protein
metabolism that is first diagnosed during pregnancy, regardless
of the severity.
2. Gestational diabetes is further classified as:
▪ Gestational diabetes characterized by an abnormal glucose
tolerance test (GTT) without other symptoms. Fasting
glucose is normal and the diabetes is controlled by diet (A1).
▪ Gestational diabetes characterized by abnormal glucose
tolerance test and elevated fasting glucose. This type of
gestational diabetes must be controlled by insulin (A2).
3. About 15,000 infants are born to mothers with diabetes each
year. Since 1980, the International Workshop-Conference on
gestational Diabetes and the American Diabetic Association has
recommended universal screening for gestational diabetes
between 24 and 28 weeks of gestation.
Aetiology
,▪ Gestational diabetes is a disorder of late pregnancy (typically),
caused by the increased pancreatic stimulation associated with
pregnancy.
Pathophysiology
1. In gestational diabetes mellitus (type III, GDM), insulin
antagonism by placental hormones, human placental lactogen,
progesterone, cortisol, and prolactin leads to increased blood
glucose levels. The effect of these hormones peaks at about 26
weeks’ gestation. This is called the diabetogenic effect of
pregnancy.
2. The pancreatic beta cell functions are impaired in response to the
increased pancreatic stimulation and induced insulin resistance.
3. Pregnancy complicated by diabetes puts the mother at increased
risk for the development of complications, such as spontaneous
abortion, hypertensive disorders, and preterm labour, infection,
and birth complications.
4. The effects of diabetes on the foetus include hypoglycaemia,
hyperglycaemia, and ketoacidosis. Hyperglycaemic effects can
include:
a. Congenital defects
b. Macrosomia
c. Intrauterine growth restriction
d. Intrauterine fetal death
e. Delayed lung maturity
f. Neonatal hypoglycaemia
g. Neonatal hyperbilirubinemia
Assessment Findings
1. Associated findings include a poor obstetric history, including
spontaneous abortions, unexplained stillbirth, unexplained
hydramnios, premature birth, low birth weight or birth weight
exceeding 4,000 g (8lb, 13 oz), and birth of a new born with
congenital anomalies.
2. Common clinical manifestations include:
▪ Glycosuria on two successive office visits
▪ Recurrent monilial vaginitis
▪ Macrosomia of the foetus on ultrasound
▪ Polyhydramnios
, 3. Laboratory and diagnostic study findings.
▪ Fasting blood sugar test will reveal elevated blood glucose
levels.
▪ A 50-g glucose screen (blood glucose level is measured 1 hour
after client ingests a 50-g glucose drink) reveals elevated
blood glucose levels. The normal plasma threshold is 135 to
140 mg/dL.
▪ A 3- hour oral glucose tolerance test (performed if 50-g
glucose screen results are abnormal) reveals elevated blood
glucose levels. (Table 1)
▪ The glycosylated haemoglobin (Hiba 1c) test (measures
glycaemic control in the 4 to 8 weeks before the test is
performed; performed on women with pre-existing diabetes)
results reflect enzymatic bonding of glucose to haemoglobin
An amino acids. This is a useful indicator of overall blood
glucose control. The upper normal level of HbA1c is 6% of
total haemoglobin.
▪ Screens for fetal (and later, neonatal) complications, including:
6.
▪ Maternal serum alpha-fetoprotein level to assess risk for
neural tube defects in new born.
▪ Ultrasonography to detect fetal structural anomalies,
macrosomia, and hydramnios.
▪ Nonstress test (as early as 30 weeks), contraction stress
test, and biophysical profile because of risk of unexplained
intrauterine fetal demise in the antepartum period.
▪ Lung maturity studies (by amniocentesis) to determine
lecithin sphingomyelin (L/S) ratio and to detect
phosphatidylglycerol (PG); the adequacy of L/S and PG,
predictor of the new-born’s ability to avoid respiratory
distress
Risk For Maternal Injury
Risk for Injury: Vulnerable for injury as a result of environmental
conditions interacting with the individual’s adaptive and defensive
resources, which may compromise health.
Risk factors
▪ Altered immune response.
▪ Anaemia.
