Pregnancy at Risk - Diabetes Flashcards
What are the 4 classifications for DM?
Type 1
Type 2
Other
Gestational
Who is considered a high risk during pregnancy (r/t diabetes)?
Women with Type 1 DM
What is the key to postive pregnancy outcomes for pts. with diabetes?
Excellent glycemic control
Diabetes is a chronic multisystem disese r/t what?
Abnormal insulin production
Impaired insulin utilization
Or both
What can trigger the onset of gestational diabetes?
Extra metabolic demands
Gestational diabetes may develop in pregnant women with risk factors for what?
Diabetes 2
What happens to the glucose of a woman with gestational diabetes after she gives birth?
It usually returns to normal
Babies born to a mom who had gestational diabetes are usually how many pounds at birth?
> 10 lbs
What hormone enables energy use and storage and decreaes blood glucose concentration?
Insulin
In pregnancy, ______ can cause insulin resistance
Progesterone
Human placental growth hormone modifies what?
The metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus
Human placental growth hormone is made by what?
The placenta
Duh! (:
When does type 1 DM usually begin?
In childhood
Type 1 diabetes has a _____ onset
Rapid
What is the cause of type 1 DM?
Unknown cause
-There is no pancreatic production of insulin
In type 2 DM, does the pancreas form insulin?
Yes; it forms SOME
In what age group does type 2 DM usually occur in?
Adults
How can type 2 DM be controlled?
By diet and exercise
What are secondary complications of type 2 DM?
Blindness
Heart attack
Stroke
Amputation
Maternal complications associated with diabetes
Hydramnios rates 10x greater (>PROM)
Infection rates higher (UTI and yeast)
Ketoacidosis can = fetal death
Preconception counseling for diabetes
Parter should be involved
FInances considered
Contraception issues require attention an dteaching
Type 2 DM pts. and Gestational diabetes can safely take on Glyburide, a sulfonyurea agent, or SQ insulin. Other agents cross placena and may be teratogenic
Fetal and neonatal complications r/t gestational diabetes
- Stillbirth >36wks
- Congenital anomaly 6-10% per pregnancy with cardiac, CNS, and skeletal most common
- Macrosomia >4000 gm, birh injuries, C/S
- IUGR r/t maternal vascular disease and increased risk for BDS
- Neonatal hypoglycemia, F&E imbalances, hyperbilirubinemia, and polycythemia
Sulfonylureas stimulate _______ production
Insulin
Insulin needs during pregnancy
- Lower in 1st trimester d/t increased production by pancreas and increased peripheral insulin sensitivity
- Increased in the 2nd trimester d/t maternal hormones acting as insulin antagonists
- Dramatic increases by 3rd trimester
- Levels off at 36 wks
- By delivery, maternal needs significantly drop
MSAFP
Found in both fetal serum and also amniotic fluid
- Pursue potential medical interventions
- Begin planning for a child w/ special needs
- Start adressing anticipated life changes
- Identify support groups
- Make a decision about carrying child to term
Blood glucose monitoring during pregnancy
Key to control
Daily urine ketone checks to pick up on ketoacidosis early on
Normal blood glucose during pregnancy
60-120 mg/dl
Fetal non-stress test
Simple, non-invasive test performed in pregnancies >28 wks gestation
When is a fetal NST done?
If baby not moving like usual
If overdue
If suspect placenta is not functioning adequately
If high risk for any reason
What can a fetal NST indicate?
- Baby is not recieving enough O2 because placental or umbilical cord problems
- Fetal distress
HbA1C
Blood glucose attatches to a hemoglobin in the RBCs
RBCs live 3 mos
When HGB/RBC is measured, it reflects average BG for prior 2-3 mos
What is the normal HbA1C?
4-6%
What level of HbA1C is diagnostic of diabetes?
> 6.5%
When might an HbA1C be inaccurate?
If pt. is also anemic
How often should HbA1C test done?
Q 3 months
When is a contraction stress test done?
At 34 wks
Contraction stress test
Oxytocin given IV
Monitor HR and contractions
O2 levels may drop, causing HR to drop
Biophysical progile (BPP)
Measures baby’s HR, muscle tone, movement, breathing, and the amount of amniotic fluid
- NST
- Fetal ultrasound
Teaching for diabetes during pregnancy?
Decrease stressors- need strict daily routine
Diet = 3 meals, 3 snacks, never skip
Acitivty= mild exercise
Insulin = appropriate dose to maximize glucose levels and reduce hypoglycemia
Rest= set sleep schedule; planned rest
BG = Keep between 60-120 depending on meals and time of day
Fetal surveillance
EDD established
Measure MSAFP between 16-18 wks d/t high rate of neural tube defects
Fetal echo to detect cardiac problems by 22 wk
Beginning at 28 wks, NST weekly
In presence of non-reactive NST, order a CST or BPP
Nursing care of pt. with diabetes who is pregnant: History
Age diagnosed Glycemic control Diet and activity Insulin use Medical and OB Hx
Nursing care of pt. with diabetes who is pregnant: Assesment
Knowledge base Motivation Support systems S&S Weight Labs (UA, urine C&S, BG, Hgb, A1c)
____% of gestational diabetics develop DM later
50%
When is gestational diabetes usually diagnosed?
in the 2nd and 3rd trimester as maternal intake and pregnancy hormones increase insulin resistance
Risk factors for gestational diabetes
Prior deliveries >4500 gm >25 yrs Obesity Family hx of type 2 DM Polyhydramnios Unexplained stillbirth
Glucose tolerance test
BG measured at intervals after the pt/ drinks a concentrated carbohydrate drink
GTT- high risk women initially and 24-28 wks
BS >139 goes to 2 hour GTT
Management of GDM
Managed like type 1 or 2 wirh focus on glycemic control
Diet and exercise (usually)
Less likely to require c/s
If you have GDM, it is typical in future pregnancies with an _____ onset
Earlier
