diabetes in pregnacy Flashcards
•Preexisting diabetes mellitus - type 1 or 2
•Gestational diabetes mellitus (GDM) - occurs during pregnancy and resolves at end
-90% of cases
-2-5% of pregnant women will develop
types of diabetes
- Insulin release accelerates in response to serum glucose
- May cause hypoglycemia
- Glucose and insulin promote development and storage of fat to prepare for fetal growth later
fuel metabolism in pregnancy - early
this is for a non diabetic
- Insulin resistance created by increase in estrogen, progesterone, and human placental lactogen (HPL)
- Allows for greater glucose availability to baby
- Normally pancreas increases insulin production
- Increased fat utilization (gluconeogenesis) provides increased available glucose for fetus
fuel metabolism in pregnancy - late
still normal, non diabetic pregnancy
- Obesity
- Preexisting hypertension
- Family hx of diabetes
- Maternal age > 25 y/o
- Previous birth of large infant
- GDM in prior pregnancy
- Fasting serum glucose > 140 mg/dl
- Previous unexplained fetal death
gestational diabetes risk factors
- Maternal hyperglycemia during 3rdtrimester associated with increased morbidity and mortality of infant
- Macrosomia - baby isn’t perfussing, so it loses weight - IUGR or baby gets extra glucose
- Hypoglycemia of infant
- Hypocalcemia
- Hyperbilirubinemia
- Respiratory distress
effects of GDM
Glucose challenge test (GCT) •24-28 weeks gestation •50 grams of oral glucose •(28 Brach jellybeans in 10 minutes) •If > 140 mg/dl rescreen with 3 hour oral glucose tolerance test
screening for GD
Oral Glucose Tolerance Test (OGTT)
•High carb diet x 3 days
•After fasting blood glucose obtained ingest 100 grams of oral glucose solution
•Levels drawn at 1, 2, and 3 hours
screening for GD
- If fasting blood sugar abnormal95 mg/dl or >
- 1 hour180 mg/dl or >
- 2 hour155 mg/dl or >
- 3 hour140 mg/dl or >
•2 or more abnormal = GDM
diagnosis for GD
Diet control first •2200-2400 kcal •Limit simple sugars and carbs or eliminate •3 meals with 2 snacks regimen Exercise Blood glucose monitoring to determine if insulin needed •Fasting > 95 mg/dl •Postprandial > 120 mg/dl Fetal monitoring •Kick counts •Nonstress test •US •Biophysical profile •Amniocentesis to check lung maturity (L/S ratio)
management for GD
TEACHING •Glucose monitoring •Diet •Insulin administration •S/S of hypo and hyperglycemia and actions (p 659 in Ricci) •Risk to self and infant if uncontrolled •Normal pregnancy
nursing managment
•Metabolic environment in 1sttrimester can affect development -Congenital malformations -Spontaneous abortion •PIH risk increased x 4 •UTI •Hydramnios (due to fetal diuresis) •Dystociasduring labor—C-section
preexisting diabetes - maternal effects
Malformations •Neural tube defects •Caudal regression •Cardiac defects Fetal growth •Macrosomia 2^ increase fetal insulin •IUGR 2^ uteroplacental insufficiency
Fetal effects
- Hypoglycemia 2^ increase fetal insulin and withdrawal of maternal glucose
- Hypocalcemia
- Hyperbilirubinemia 2^ compensation to hypoxia
- Respiratory distress syndrome 2^ delayed surfactant production
neonatal effects
•Thorough history and physical
-History of her diabetes and management
•Labs include routine prenatal, thyroid, HbA1c, urine for glucose and ketones, WBCs
maternal assessment
- Fundal height
- Maternal serum alpha-fetoprotein (MSAFP) at 16 weeks—screen for neural tube, Downs
- US
- Kick counts
- NST
- Biophysical profile
fetal monitoring
