Gestational Diabetes Flashcards
describe pregestational diabetes
type 1- no insulin production
type 2- decreased insulin production
*both will have greatly increased diabetic complications
what is IUFD
intrauterine fetal demise is loss of fetus in utero
what is HCS also known as
HPL
what is IUGR
intrauterine growth restriction
what is gestational diabetes
carbohydrate intolerance (variable severity)
may require insulin for regulation
4-14% of all pregnant women
does gestational diabetes persist after pregnancy
it may
50% of gestational will convert to type 2 following pregnancy
when is gestational considered resolved
about 15-24 hrs after placenta delivers
risk factors of gestational diabetes
hx of gestational dm, family hx of dm, previous infant > 9 lbs, previous IUFD, obesity, >25 yrs
patho of gestational diabetes
human chorionic sommatomamotropin (HCS) causes insulin resistance
insulin needs in 2nd and 3rd trimester
increase in HCS causes need for MORE insulin
describe glucose in relation to fetus
primary fuel for fetus, glucose crosses placenta, insulin does NOT cross
what causes gestational diabetes
sensitivity to HCS or HPL
potential maternal morbidity with diabetes
preeclampsia, infection, postpartum bleeding, cesarean section
describe the maternal morbidity causes
preeclampsia; due to vascular inflammation
infection; due to increases glucose
postpartum bleeding; due to large fetus
cesarean section; due to large infant
potential fetal morbidity with diabetes
macrosomia, IUGR, neonatal hypoglycemia, decrease in surfactant
describe the fetal morbidity causes
macrosomia/birth trauma; d/t maternal hyperglycemia
IUGR; poor placental perfusion
neonatal hypoglecemia; monitor BS 3 hrs after birth
higher circulating glucose=
LOWER SURFACTANT production
decrease in surfactant…
5x greater risk of respiratory distress
what is amniocentesis
test amniotic fluid to determine if fetus has enough surfactant to be born (usually done when woman comes in preterm and she is contracting)
signs and symptoms of gestational diabetes
hydramnios, macrosomnia/ increased fundal ht, persistent glycosuria, ketonuria
what is hydramnios
too much amniotic fluid
what do you want the non fasting glucose level below
130
if nonfasting glucose is ___ then immediately diabetic and no need for OGTT
200
if > 200 lbs at prenatal entry…
assess glucose (GST) at first visit AND then also at 24 weeks
if low risk or normal weight at prenatal entry…
GST between 24 and 28 weeks of pregnancy
how does GST work
glucose screening test
administer 50 g of glucose
no fast, if >130 mg/dL then need a 3 hr OGTT
how is OGTT done
fast
check initial, 1 hr, 2 hr, and 3 hr
if two of four glucose levels are elevated then diabetic
treatment for gestational diabetes
diet (50% from carbs), exercise, daily BG log (1-4x a day)
diet if obese and normal wt
obese: 1500 cal restriction
normal: 2400 cal restriction
drugs for gestational diabetes
oral hypoglycemic drugs
insulin
oral hypoglycemic drugs for gestational
Glyburide: sulfonylurea(increases insulin production from beta cells)
Metformin: biguanidine (decreases gluconeogenesis in liver and decreases glucose)
insulin regimen for gestational
2:1 ratio, NPH and regular taken before dinner and breakfast
how do insulin needs change towards end of pregnancy
during pregnancy: insulin needs continue to increase
during labor: may/may not need insulin
during postpartum: decrease at 24 hr after loss of placenta due to DECREASE in HPL
important nursing care for gestational diabetes
EDUCATION
poor glycemic control effects
dietary teaching and exercise review
prenatal care for gestational dm
prenatal care every 2 wks until 3rd trimester (then every week)
routine non stress test to ensure placenta not damaged
what should be regularly checked for diabetes
check Lecithin-sphingomyelin ratio
L/S ratio for lung maturity
what happens if L/S ratio is low
will NOT deliver because surfactant is too low
what needs to be monitored at birth if gestational diabetes
monitor for hypoglycemia at birth
DKA in gestational
diabetic ketoacidosis
neurological squeale due to ketosis
perinatal mortality= 90% if DKA
maternal mortality=5-15% if DKA
