Values
What is the ideal serum glucose level during pregnancy, before meals or fasting?
60-99 mg/dL
Who is screened for GDM?
Glucose screening should be performed on all pregnant women.
What is gestational diabetes?
GDM is an impaired tolerance to glucose with the first onset or recognition during pregnancy.
GDM starts when the body is not able to make or use insulin during pregnancy.
A healthy term newborn's blood glucose should be between?
40-60 mg/dL
What are the 3 manifestations (S/S) of hyperglycemia?
Polydipsia
Polyphagia
Polyuria
Nausea
Abdominal pain
Flushed dry skin
Fruity breath
What is the ideal glucose reference level 2 hours after a meal?
< 120 mg/dL
How is GDM initially managed?
How do you obtain a glucose value for monitoring glucose in the newborn?
Heel stick
What is hypoglycemia in the first 3 days of life defined as?
<40 mg/dL
Name 2 maternal risks after delivery.
Preeclampsia
C-section
Development of T2DM
Kidney damage
What is the prevalence of gestational diabetes?
Every year, 2% to 10% of pregnancies in the United States are affected by gestational diabetes.
What is the typical carbohydrate intake restricted to in GDM?
50% of caloric intake
What percentage of mothers are at risk for developing type 2 diabetes later in life?
50-70% are at risk
When does the newborn's source of glucose stop?
When the umbilical cord is clamped
What are 4 expected findings of hypoglycemia in baby?
Poor feeding
Jitteriness/ tremors
Hypothermia
Weak cry
Lethargy
Flaccid muscle tone
Seizures/coma
Irregular respirations
Cyanosis
Apnea
During labor what range should blood glucose be between?
80-110 mg/dL
Decreases the incidence of neonatal hypoglycemia
Why is exercise recommended?
Increasing lean muscle mass improves sensitivity to insulin
What testing is started between 28-32 weeks of gestation if the pregnancy is complicated?
Non-stress tests, used twice a week.
NST: antepartum evaluation of fetal well-being performed during the 3rd trimester.
Noninvasive test that monitors the response of FHR to fetal movement.
For an asymptomatic newborn that has a glucose level <25 mg/dL in the first 4 hours or <35 mg/dL from 4-24 hours, what should you do to increase levels?
Offer oral feedings
If newborn is symptomatic, initiate IV dextrose.
Glucose gel can also be used.
Name 3 risk factors for developing GDM.
Obesity
HTN
Glucosuria
>25 years old
Family history of DM
Previous delivery of an infant that was large or stillborn
Per Beaumont's policy, when should a pregnant woman be tested for gestational diabetes?
During 23-28 weeks of gestation.
A 2-hour, 75g OGTT is performed.
-Overnight fast & normal food intake
-Diagnosis by 1 or more:
Fasting glucose: 92-125mg/dL
1-hour: >180 mg/dL
2-hour: 153-199 mg/dL
Explain how to perform a daily kick count.
This test is used to determined if baby is under stress or could indicate a problem.
Clients should count fetal activity 2-3 times a day for 2 hours after meals or bedtime.
Fetal movements <3 per hour or movements that cease for 12 hours indicates need for further assessment. Or 10 movements per 2 hours.
What test is indicated during labor to monitor the newborn?
GDM is an indication for continuous external fetal monitoring by placing an ultrasound transducer over the client's abdomen to monitor FHR and a tocotransducer on the fundus to record uterine contractions.
Name 3 fetal risks after delivery.
Macrosomia
Birth trauma
Electrolyte imbalance
Hypoglycemia
Hyperglycemia
Infections
Hydramnios
Ketoacidosis
True or false. Insulin crosses the placenta?
False. Insulin does not cross the placenta, glucose does. When GDM is poorly controlled the pancreas works overtime to produce insulin but because insulin cannot be properly used, glucose levels keep rising. When glucose continuously crosses the placenta, it puts the baby at risk for macrosomia.