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Presentation On: Kgmu College of Nursing
Presentation On: Kgmu College of Nursing
PRESENTATION ON
PRESENTED BY:-
Deeksha
M.Sc.(N) 1st yr
INTRODUCTION
This diagnosis is given when a woman, who has never had diabetes before,
gets diabetes or has high blood sugar, when she is pregnant. Its medical name
is gestational diabetes mellitus or GDM. It is one of the most common health
problems for pregnant women. The word “gestational” actually refers to
“during pregnancy.”
DEFINITION
DIABETES MELLITUS:-
A metabolic condition characterized by chronic hyperglycemia as a result of
defective insulin secretion, insulin action or both.
GESTATIONAL DIABETES:-
• Defined as carbohydrate intolerance of variable severity with onset or first
recognition during pregnancy. • The entity usually presents late in the second or
during the third trimester.
INCIDENCE
GDM develops when a stage is reached, when the pancreas despite the
increased insulin production cannot counter the insulin resistance caused by
the pregnancy hormones.
GDM usually occurs in women with poor pancreatic reserve and insulin
resistance such as those with polycystic ovary syndrome or a family history
of diabetes. It usually appears after 24 weeks of pregnancy.
CLINICAL FEATURES:-
SYMPTOMS:-
Weight loss during early
weight gain or Excessive weight gain during pregnancy 2nd and third trimester of
pregnancy
Polyuria (frequent urination)
Polydipsia (increased thirst)
Polyphagia(increased hunger)
Fatigue , Weakness
Tingling or numbness in hands or feet
SIGNS :-
Polyhydramnios
Fundal height more than period of gestation
Signs of dehydration
Vision impairment
Kusummal breathing
WHY DIDN’T I HAVE DIABETES
BEFORE?
History collection:
EXAMINATIONS-
Physical findings:
Blood pressure, heart rate, weight (measured every day while the patient is
hospitalized)
Height of uterine fundus measured once per week
Pelvic examination: check for indications of premature birth; vaginal culture
INVESTIGATIONS
NON-PHARMACOLOGICAL TREATMENT
Diet therapy: 25-30 kcal/kg/day
During pregnancy, as pregnant women patients need to consume adequate
energy, protein, and minerals
Either low-carbohydrate, low-fat calorie-restricted, may be effective in the
short-term diet for a pregnant woman with diabetes includes:
at least 175 g/day of carbohydrate, 28 g/day of fiber and 1.1 g of protein per
kg/day
Medical Nutrition Therapy
According to the ADA nutrition practice guidelines there are three clinical
goals for treatment
Pre-conception management
Aim to maintain HbA1c < (6.1%) to reduce the risk of congenital
malformations
advise women with HbA1c > (10%) to avoid pregnancy.
Reinforce self-monitoring of blood glucose.
Offer HbA1c testing monthly
retinal assessment at the first pre-conception appointment and then
annually if no retinopathy is found.
Intrapartum management
preterm, steroids are given to the woman to improve fetal lung maturation and
additional insulin may be required.
If the fetus is macrosomic, the woman should be informed of the risks and
benefits of vaginal birth, induction of labour and caesarean section.
Blood glucose levels should be monitored hourly through labour and birth
Care of the baby at birth
A pediatrician should be present at the birth if the woman is receiving insulin.
Observe for signs of respiratory distress, hypoglycemia, hypothermia, cardiac
decompensation and neonatal encephalopathy
A baby should be admitted to a neonatal intensive care unit (NICU) only if a
significant complication is apparent.
The woman should hold her baby after the birth and prior to any transfer to the
NICU.
Blood glucose testing of the baby should be carried out after birth and at intervals
according to local protocols
The baby should feed within 30 minutes of birth and then every 2–3 hours .
Postnatal care of the woman with
Type 1 diabetes:
insulin should be reduced immediately after birth and blood glucose levels
monitored.
observed for signs of hypoglycemia.
As placental hormone levels fall, the insulin sensitivity improves, such that the
insulin infusion rate is likely to need reducing in the early postnatal period.
GDM: follow up
A fasting blood glucose test should be undertaken at 6 weeks
The woman should be advised of the risk of developing diabetes in future
pregnancies and the need for pre-pregnancy screening.
Informed of the importance of using contraception to prevent pregnancies
A healthy lifestyle with regular exercise, smoking cessation and maintaining a
BMI within normal limits should also be emphasized to the woman.A follow-up
appointment at 6 weeks with the diabetes team
COMPLICATION:
Fetal complication:
Hypoglycemia
Polycythemia
Hyperbilirubinemia- increase chance of jaundice
SUMMARY: -
CONCLUSION
ASSIGNMENT