Summary of "Gestational Diabetes Mellitus (Pregnancy) Nursing Care, Symptoms for Maternity Nursing"

Key Wellness Strategies, Self-Care Techniques, and Productivity Tips for Gestational Diabetes Management

Risk Factors for Gestational Diabetes (Mnemonic: MAMA)

M: Maternal age over 25
A: Overweight or obese (BMI > 25 or > 30)
M: Macrosomia (previous baby > 9 pounds)
A: Multiple pregnancies
A: History of gestational diabetes or family history of diabetes

Pathophysiology Overview

Pregnancy hormones such as human placental lactogen, estrogen, cortisol, and progesterone reduce insulin sensitivity to increase glucose availability for the baby. Normally, the mother’s body compensates by increasing insulin production. Gestational diabetes occurs when insulin resistance is too high and compensation fails, causing hyperglycemia.

Key points include:

Excess glucose crosses the placenta, leading to macrosomia and increased risk for cesarean section.
The baby may experience hypoglycemia after birth due to high insulin levels.
Increased glucose in the mother’s urine raises the risk of urinary tract infections and yeast infections.
Gestational diabetes increases the mother’s risk of developing type 2 diabetes later in life (about 50%).

Signs and Symptoms of Gestational Diabetes (Mnemonic: 3 P’s + S)

Polyphagia (excessive hunger)
Polydipsia (excessive thirst)
Polyuria (frequent urination)
Sugar in urine (glycosuria)
Additional signs: fruity breath, dry mouth, infections

Screening and Diagnosis (Mnemonic: SUGAR BABE)

S: Screening at 24-28 weeks gestation with a 1-hour 50g oral glucose tolerance test (OGTT)
- Abnormal if glucose > 140 mg/dL
If abnormal, proceed to 3-hour 100g OGTT with fasting
- Diagnostic if two or more values exceed thresholds:
  - Fasting > 95 mg/dL
  - 1 hour > 182 mg/dL
  - 2 hour > 155 mg/dL
  - 3 hour > 140 mg/dL

Nursing Care and Management

Diet and Exercise: First-line management to maintain blood glucose within target ranges.
Medication: Insulin or oral hypoglycemics (e.g., glyburide) if diet and exercise are insufficient.
Glucose Monitoring:
- Daily self-monitoring at home
- Fasting glucose target: 70-95 mg/dL
- Postprandial (1 hour after meals) target: < 140 mg/dL
Urine Monitoring: Check for glucose and signs of infection at prenatal visits.
Monitor Blood Glucose During Labor: Maintain 70-130 mg/dL to reduce neonatal hypoglycemia risk.
Postpartum Monitoring:
- Monitor for hypoglycemia in both mother and baby.
- Conduct glucose testing 6-12 weeks postpartum (2-hour OGTT).
- Educate on lifelong risk of type 2 diabetes and recommend testing every 1-3 years.

Complications to Watch For

For Mother:
- Hypertension
- Preeclampsia
- Urinary tract infections
- Yeast infections
- Preterm labor
- Increased cesarean risk
For Baby:
- Macrosomia
- Hypoglycemia at birth
- Respiratory distress syndrome due to delayed lung maturity