maternity week 3 Flashcards
CLASSIFICATION OF DIABETES
*DIABETES MELLITUS: Type I
*DIABETES MELLITUS: Type II
*DM: Other specific types: (i.e. drug induced) *GESTATIONAL DIABETES (GDM): only during pregnancy
GESTATIONAL DIABETES
- CLASS A‐1—2 abnormal values on OGTT, fasting blood glucose normal, diet controlled
- CLASS A‐2—requires medication to control, not known to have DM prior to pregnancy
PREGESTATIONAL DIABETES
- CLASS B—onset > age 20 (duration < 10 y)
- CLASS C—onset 10‐19y +/or duration 10‐19 y * CLASS D—onset < 10 y +/or duration > 20 y
- CLASS F—diabetic nephropathy
- CLASS R—retinitis proliferans
- CLASS T—renal transplant
DIABETOGENIC EFFECT OF PREGNANCY
- Metabolism directed towards supplying adequate nutrition to the fetus
- Increased resistance to insulin
- Compensatory increased production of insulin by
the pancreas - Post Partum: Return to pre‐pregnant metabolism
1st Trimester
- estrogen /progesterone stimulate beta cells to increase insulin production
- Promotes increased use of glucose and decreased blood glucose
- Increase in glycogen stores and decrease in glucose production
WOMEN WITH INSULIN DEPENDENT DIABETES ARE PRONE TO
HYPOGLYCEMIA 1ST TRIMESTER
2nd and 3rd Trimesters
Increased insulin resistance and increased hepatic production of glucose
*Polyhydramnios (hydramnios) *Pre‐eclampsia
*Ketoacidosis
*C/S
*Instrument delivery (vac, forcep) *Shoulder dystocia
*SAB
*Infections
INFLUENCE OF DIABETES ON THE
FETUS
*Anomalies *Macrosomia *Fetal demise *Birth trauma *Neonatal
* Hypoglycemia
* RDS
* Polycythemia
* Hyperbilirubinemia
*Miscarriage/SAB
INFLUENCE OF DIABETES ON FETAL/NEONATAL OUTCOME
Anomalies
* NTD
* Anencephaly or
microcephaly * Heart defects
Macrosomia
Diabetes NURSING CARE
For Type I or II, women should have pre‐conceptual care to stabilize their DM before becoming pregnant.
*HgbA1c <6%
*Blood glucose between 60‐120 mg/dl 10 postprandial
*BP < 130/80
*BMI < 27
*Assessment of thyroid function, nephropathy, and retinopathy
*Teaching on healthy lifestyle, low glycemic foods and folic acid
Diabetes NURSING CARE
Screening 24‐28 weeks.
Those at high risk for GDM will be screened in the first semester then again @ 24 – 28 weeks
Diabetes NURSING CARE
- Thorough OB history
Diabetes NURSING CARE- Lab tests: HgA1c
- Retinopathy,
neuropathy - Diet
- BMI
Diabetes‐NURSING CARE Risk Assessment
- No history of glucose intolerance
- Younger than 25 years old
- Normal body weight
- No family history (first‐degree relative) of
diabetes - No history of poor obstetric outcomes
- Not from an ethnic/racial group with a high
prevalence of diabetes
Diabetes‐NURSING CARE Risk Assessment
- Previous infant with congenital anomaly
- History of GDM or polyhydramnios in a previous
pregnancy - Previous LGA infant
- Previous unexplained fetal demise or neonatal
death - Maternal obesity (body mass index [BMI] over
30) - Hypertension before pregnancy or in early pregnancy
ACOG ‘2 step’ approach
ACOG ‘2 step’ approach (24 – 28 week 1 hour venous glucose measurement following 50g oral glucose solution), followed by a 100g 3 hour oral glucose tolerance test (OGTT) if positive
diagnosis of GDM is based on
2 abnormal values on the 3 hour OGTT
Screening
Fundal Height
Blood Tests for genetic screening Ultrasound for physical anomalies Echocardiogram for heart anomalies
Lab Tests: U/A and Culture, Serum Glucose, Glycosylated Hgb (A1c), Electrolytes and Renal Function
Target Blood Glucose in PG
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NUTRITION
Counseling by registered dietician/nutritional team if available
NUTRITION
- Follow prescribed diet plan
- Eat well‐balanced diet
- Divide daily food intake among 3 meals, 2 ‐3 snacks
- Eat a substantial bedtime snack to prevent severe drop in BG
level during night - Take daily vitamins and iron as prescribed
- Avoid refined sugar foods
- Eat consistently each day; don’t skip meals or snacks
- High dietary fiber foods
- Avoid alcohol and nicotine, lhimttpi:t//cwawfwf.echinooesemyplate.gov/images/MyPlate
- Avoid nonnutritive sweeteners as able
NUTRITION ‐ Glycemic Index
Used to measure the effect of foods on blood sugar level
Low: 55 or less Medium: 56–69 High: 70 or above
NUTRITION ‐ Glycemic Index
- Foods high in refined carbs and sugar are digested more quickly and have a higher GI.
*Other things that effect GI are: acidity, cooking time, how processed a food is , how ripe something is.
NUTRITION ‐ Glycemic Load
- (Grams of carbohydrate X Glycemic Index)/100 = Glycemic Load
Low GL: 10 or less Medium GL: 11 to 19 High GL: 20 or higher
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