11.1c Gestational Diabetes

Question 1

Gestational Diabetes

Answer 1

• Diagnosed during second half of pregnancy

- Fetal nutrient demands rise in late 2nd and 3rd trimesters

Question 2

Early Pregnancy Screening

Answer 2

• All woman who are unknown should be screened via medical history, clinical risk factors, lab and glucose screenings
• Screened 24-28 weeks of gestation
• Earlier if risk factors are strong

Question 3

2 Step Screening Method

Answer 3

• 1 hour glucose screen (50g oral sucrose)

IF NEGATIVE (<140 mg/dL) 
- Routine prenatal care

IF POSITIVE (>130 mg/dL)

• 3 hour glucose test (100g)
• If negative - normal prenatal care
• If positive - they are positive for gestational diabetes

Question 4

Positive GDM Values

Answer 4

• 2 or more values are met or exceeded

FASTING - 95-105 mg/dL
1H - 180-190 mg/dL
2H - 155-165 mg/dL
3H - 140-145 mg/dL

Question 5

1 Step Method

Answer 5

• 2H Glucose Test (75g)
  Negative result is negative

Positive results (one value is met or exceeded)
FASTING - 92mg/dL
1H - 180 mg/dL
2H - 153 mg/dL

Question 6

Fetal Risk

Answer 6

• No risk of birth defects if developed after 1st trimester
• Obesity can also cause birth defects though
• Macrosomia with associated birth trauma risk
• Hypoglycemia
• Hyperinsulinemia

Question 7

DIAGNOSIS REDUCED GLUCOSE REGULATION

Answer 7

OUTCOME
- Maintain euglycemic state throughout pregnancy

INTERVENTIONS

• Assess current knowledge on management and disease
• Educate diet and self glucose monitoring
• Review s/s of hyper/hypoglycemia

Question 8

DIAGNOSIS FETAL INJURY DUE TO ELEVATED GLUCOSE

Answer 8

OUTCOME
- Fetus remains free of injury

INTERVENTIONS

• Assess woman’s current diabetic control by reviewing blood glucose values
• Assess fetal movement and heart rate during each visit
• Educate daily fetal movement counts

Question 9

DIAGNOSIS ANXIETY RELATED TO THREAT OF FETAL WELL BEING

Answer 9

OUTCOME
- Reports lower level of anxiety

INTERVENTIONS

• Therapeutic communication, unhurried environment, and encourage verbalization of concerns.
• Identify any misinformation the woman may think
• Educate importance of scheduled visits, assessments, and anticipated management of labor/birth

Question 10

Antepartum Care

Answer 10

• Fasting Blood Glucose 95
• 1 Hour post Meal Glucose 140 mg/dL
• 2 Hour post Meal Glucose 120 mg/dL

Question 11

Diet

Answer 11

• 2000-2500 Cal a day
• 35 kcal/kg/day for average weight
• 15-25 kcal/kg/day for overweight/obese

Question 12

Exercise

Answer 12

• Few studies published on benefits of exercise in women with GDM

Question 13

Pharmacological Therapy

Answer 13

• Metformin - Decreases hepatic blood glucose production and increases insulin sensitivity
• Glyburide - Pancreas produces more insulin

Question 14

Diabetics who Require Insulin or Oral Hypoglycemic Agents

Answer 14

• NST beginning at 32 weeks twice a week

Question 15

PostPartum Care

Answer 15

• Most return to normal after birth
• Children are more at risk for type 2 DM
• All women should be assessed with 75g OGTT test or fasting plasma glucose 6-12 weeks postpartum
• Oral contraceptives are safe to use for postpartum GDM patients