What is GDM + prevalence + policies
According to the American Diabetes Association, Any degree of glucose intolerance with onset or first recognition during pregnancy without having a history of type 1 or type 2 diabetes.
Gestational diabetes
Who is screened for gestational diabetes?
Every pregnant women in the 24-28 weeks of gestation
Who should the nurse consult with to learn more about a gestational diabetic diet?
Nutritionist
What is the biggest fetal complication from a GDM birth?
Macrosomia and neonatal hypoglycemia
Where in the body is insulin produced?
Pancreas
What happens to the body to make GDM happen?
Your body does not properly regulate the insulin levels in your body, resulting in an increase in glucose (hyperglycemia).
1 hr Glucose challenge test followed by 3 hr glucose challenge test to confirm
What is an effective way to educate a mother about checking blood glucose levels at each meal?
Teach-back method and demonstration
A mother is worried her male child will develop gestational diabetes once he gets older, what should you tell her?
Gestational diabetes only occurs in women who are pregnant and have hyperglycemia in their 2-3rd trimester.
T or F: post meal glucose levels are higher after a meal?
True: due to increased insulin resistance, making more glucose available to the fetus
According to CDC 2019, between ____ of pregnancies are complicated with gestational diabetes in the United States.
2-10%
Levels above ___ indicate a positive glucose challenge test
140 mg/dL
What would the nurse ask the laboring women who are at risk for GDM?
Hx of GDM, diabetes, stillbirth, macrosomia baby, exercise habits, eating habits, prenatal visits with OBGYN
An increased risk of fetal mortality is due to what?
Uncontrolled diabetes in the 3rd trimester.
What happens to the fasting blood glucose levels as glucose passes to the fetus?
Decreases due to the babies needs for energy
What are policies for GDM?
Ensure maternal and baby safety, prolong stay if unstable.
Obesity, prior macrosomia baby, prior still birth, and history of GDM
Risk for GDM
What would you educate the mother about to limit chances of developing GDM?
Incorporate physical activity, follow a diet, monitor glucose levels, ASK FOR HELP!
Other than macrosomia and neonatal hypoglycemia, what are additional risk for a GDM birth?
Birth injuries and cesarean birth.
How does the mother use energy in the second half of pregnancy?
Use of fatty acids
Where could the baby go if they are experiencing hypoglycemia from GDM birth?
Transition unit or NICU
What medication is used to treat GDM?
Insulin traditionally, but it doesn't cross the placental. Metformin and glyburide are also used
When a mother who was recently diagnosed with GDM and anxious asks you what a “diabetic diet is” what would you tell them?
There is not a one size fits all diet. Carbohydrates make glucose levels spike the most, therefore it is important to monitor these the closest.
Why is a baby at an increased risk for respiratory distress syndrome when born from a GDM mother?
Fetal hyperinsulinemia slows cortisol production, cortisol is needed for surfactant production which helps keep the newborn’s alveoli open
What influences the decrease of maternal tissue sensitivity to insulin in week 20-40?
Human chorionic somatomammotropin (hCS), prolactin, Estrogen, Progesterone, Cortisol