Gestational Diabetes Mellitus: Women and Newborn Health Nursing (NURSE 419)

Gestational Diabetes
Mellitus
Women and Newborn health nursing ( NURSE 419 )
Instructor names:
Dr, Hannah Dava Priya
Ms; Fralyn Abellanosa Gabuya
Ms, Rawan Abdullah Alhuzaym
Students name:
Maryam Alghuwainem 391230584
Hakeemah Alnazal. 391230560
Albandari Almusaylim 391230575
Shaden Almuqaybil. 391230558
Gestational Diabetes Mellitus
Objective
● Define gestational diabetes Mellitus

● Identify the Incidence and risk factors
● Identify clinical manifestation
● Describe the complications for the mother and baby
● Discuss the management
● Discuss the evidence bases
Outline
● 1. Case scenario :
● • Patient history
● • Patient assessment
● • Laboratory and diagnostic investigations
● • Medications
● • Patient's perception of her illness Nursing care
plan
● 1. DISEASE CONDITION :
● • Definition of Gestational diabetes mellitus
Incidence and risk factors
● • Clinical manifestation Complication for the
mother and baby Management
● • Evidenced based practice
● • References.
Patient history
Name of the Patient: Sajedah

Age:38 years
Married: non-consanguineous
Husband: works as engineer
Diagnosis: SVD, laceration sutured , ebl 250 ml

Gestational diabetes Mellitus
G2 P1 @ 39 weeks of gestation
Past medical history: Had regular menstruation. Not diabetic or hypertensive

Present history – pain and leaking per vagina.
Present pregnancy: had hyperemesis and bleeding in 2weeks of pregnancy.
Family history: : Uncle is Diabetic and Hypertensive
Personal history: prefers – Diet no preference, non-smoker
Assessment :
1 day post-partum – findings

Linea nigra, Chloasma, abdomen protruded, umbilicus – flat.
Uterus- boggy and soft
Fundal height: 2 Finger above umbilicus.
Lochia – normal,
BP is high - 126/90 mm HG, pulse 100bpm, Respiration 28 bpm, Sao2 – 92%, SOB
Lap Investigation :
1. Hgb: 9.2 gm/dl (12.0 to 15.5 gm/dl)

2. WBC: 10.5 109/L (4.5 to 11.0 × 109/L)
3. Platelet: 350 (150 to 400 × 109/L)
4. Glucose: 185 mg/dl
5. The Glucose Challenge Test & The Oral
Glucose Tolerance Test -Explain this test
Test
Oral glucose tolerance test:

fast overnight and measure the
fasting blood sugar level after that
drink sugary liquid and preform
blood sugar test for the next two
hours periodically.
Glucose challenge test:

initially drink syrup glucose solution after
one hour preform blood test to measure
blood sugar level.
Medication :
Tab. Folic acid (5mg) daily
Drug class: Vitamin (type of vitamin B)
Function:Help in reduce the risk of neural tube defects

such as: spina bifida
Side effects:
-nausea , loss of appetite
-bloating and gas
-confusion
-feel excited or irritable
-depression
Patient perception of illness
She feels that she will deliver the baby

and anxious about the blood glucose
sugar.

Nursing Care Plan

Nursing Care Plan
After half of -Allow mother to ask The goal is

lab Anxiety related to an hour of questions and ventilate met.After
investigation of perceived threat nursing her feelings half an hour
glucose =185 to the health of intervention -assign mother to mother
mg/dl the fetus as mother will be regular antenatal show less
evidenced by less anxious checkup to maintain anxious
mother’s feel regarding the glucose level within about her
anxious about the health of her normal range fetus health.
blood glucose fetus. -Involve family members
sugar. in the care
mother feel
-Educate the mother
anxious about the
about the disease
blood glucose
process and treatment
sugar
including relationships
between diet, exercise,
stress and insulin
requirements.
Nursing Care Plan
After 2 days of 1- Instruct the client about The goal is

nursing medications that may met ,After 2
Hgb: 9.2 gm/dl Fatigue related to
intervention stimulate RBC production days nursing
(12.0 to 15.5 decrease
patient will in the bone marrow. intervention
gm/dl) BP is high - hemoglobin as
verbalize patient
126/90 mm HG evidence by Hgb is
reduction of 2-Provide supplemental verbalized
Sao2 – 92%. 9.2 mg/ dL
fatigue as oxygen therapy as reduction of
pulse 100bpm,
evidenced by needed. fatigue as
Respiration 28
reports of evidenced by
bpm
increased energy 3-Anticipate the need for reports of
and ability to the transfusion of packed increased
Fatigue / weakness- perform desired RBCs. energy and
Shortness of breath activities. ability to
4-Educate energy- perform
conservation techniques. desired
activities.
Nursing Care Plan
Risk for ineffective After nursing -Assist client and/or family the mother
lab health intervention the to learn glucagon show better
investigation of maintenance mother will be able administration control on
glucose =185 related to deficient to have enough -Motivate the mother to the diabetes
mg/dl knowledge of the knowledge to comply with regimen
effects of maintain health -Review all recommended
pregnancy on plan for diet and exercise
diabetes control. during pregnancy
-Provide information
regarding the impact of
pregnancy on the diabetic
condition and future
expectations
-Educate the mother about
the management during
pregnancy
Definition Of gestational diabetes mellitus:
Gestational diabetes mellitus (GDM) is a

condition in which a hormone made by the
placenta prevents the body from using insulin
effectively. Glucose builds up in the blood
instead of being absorbed by the cells.
Risk factors
Obesity inactivity
family history of type 2

abnormal
diabetes
cholesterol level
-Race
previous pregnancy history vascular disease

of gestational diabetes
Incidence:
There is highly incidence of developing type 2

diabetes for women with GDM in pregnancy
range between 40% to 60%.
Clinical manifestation
Maternal complications
Neptune :
2- cesarean birth
1-Hypertension:(pre-eclampsia ):
characterized by high blood
pressure . Sign of damage to
another organ system, most
often the liver , kidneys and 3-perinatal or postpartum
vascular impairment. depression
5- future diabetes: mother 4-Birth injury to maternal

with GDM have higher risk of tissue ( hematoma,
type 2 diabetes as they get lacerations). Because of fetal
older. size ( macrosomia) causing
difficult birth.
fetal complications:
1
2
macrosomia ( > 4000 g) : early ( preterm ) labor :
fetal hyperglycemia stimulating preterm premature rupture of
production of insulin to metabolize membranes birth or may be
carbohydrate; excess nutrients recommended because of the
baby size.
3
4 hypoglycemia ;
baby might have a greater Neonatal hyperinsulimemia after
chance of obesity and birth when maternal glucose is no
diabetes longer available( but insulin
production remains high).
fetal complications:
1
2
shoulder dystocia : when the temporary Respiratory distress
baby's shoulder get stuck inside syndrome( RDS) : mainly because of
the mother pelvis during labor. delayed maturation of fetal lung;
inadequate production of pulmonary
surfactant.
3
4 jaundice
stillbirth: untreated GDM can
result in a baby’s death either
before or shortly after birth.
Gestational Diabetes Management
Diet ; for food affected by GDM. It should provide diet, nutrition

and nutrients necessary for the health of the mother and fetus, and
appropriate weight promotion. It should be based on an average of
30 kcal/kg/day.a calorie limit of 25 kcal/kg may be recommended for
an obese woman .Calories should be divided between three meals
and three snacks
Exercise : reduces the need for insulin in the woman with GDM
. exercise and an active lifestyle can improve cardiorespiratory
fitness. A graduated physical exercise program should be
recommended by a physician who takes into account each
woman's risk factors
Blood Glucose Monitoring ;

Blood glucose levels should be evaluated to determine whether
levels are normal . A com mon method is measurement of fasting
blood glucose level ( no food for the previous 4 hours ) and 75
postprandial blood glucose level ( 2 hours after each meal ). .
%
Additional tests for glucose levels may be performed as needed .
Fetal Surveillance: Testing to identify fetal compro mise may begin as

early as 28 weeks of gestation if the woman has poor glycemic control or
by 34 weeks of gesta tion in lower - risk women with gestational diabetes.
The surveillance testing often includes " kick counts , " ultrasonog raphy
for fetal growth and amniotic fluid volume , biophys ical profile , nonstress
test , contraction stress test , or amnio centesis for fetal lung maturity
Therapeutic Management includes oral anti-diabetic

medications, such as metformin and glibenclamide, which are
an alternative to, or can be used alongside, insulin to control
the blood sugar.
Video
https://youtu.be/rnl0Pp8WtXA
Questions
- List some of the factors that can lead to

GDM?
- What type of diabetes is highly to develop
next in life for women with GDM?
- How can we manage the GDM ?

Evidance bases:
Introduction: Gestational diabetes mellitus (GDM) is a
of the major public health issues in Asia. The present
study aimed to determine the prevalence of, and risk
factors for GDM in Asia via a systematic review and
meta-analysis.
Methods: We systematically searched PubMed, Ovid, Scopus

and ScienceDirect for observational studies in Asia from
inception to August 2017. We selected cross sectional studies
reporting the prevalence and risk factors for GDM. A random
effects model was used to estimate the pooled prevalence of
GDM and odds ratio (OR) with 95% confidence interval (CI).
Results: Eighty-four studies with STROBE score ≥ 14 were included in

our analysis. The pooled prevalence of GDM in Asia was 11.5% (95% CI
10.9–12.1). There was considerable heterogeneity (I2 > 95%) in the
prevalence of GDM in Asia, which is likely due to differences in diagnostic
criteria, screening methods and study setting. Meta-analysis
demonstrated that the risk factors of GDM include history of previous
GDM (OR 8.42, 95% CI 5.35–13.23); macrosomia (OR 4.41, 95% CI
3.09–6.31); and congenital anomalies (OR 4.25, 95% CI 1.52–11.88).
Other risk factors include a BMI ≥25 kg/m2 (OR 3.27, 95% CI 2.81–3.80);
pregnancy-induced hypertension (OR 3.20, 95% CI 2.19–4.68); family
history of diabetes (OR 2.77, 2.22–3.47); history of stillbirth (OR 2.39,
95% CI 1.68–3.40); polycystic ovary syndrome (OR 2.33, 95% CI1.72–
3.17); history of abortion (OR 2.25, 95% CI 1.54–3.29); age ≥ 25 (OR
2.17, 95% CI 1.96–2.41); multiparity ≥2 (OR 1. 37, 95% CI 1.24–1.52);
and history of preterm delivery (OR 1.93, 95% CI 1.21–3.07).
Conclusion: We found a high prevalence of GDM among the

Asian population. Asian women with common risk factors
especially among those with history of previous GDM,
congenital anomalies or macrosomia should receive additional
attention from physician as high-risk cases for GDM in
pregnancy
Reference
● Alfadhli, E. M. (2015, January 1). Gestational diabetes
mellitus. Saudi Medical
● Journal. Retrieved October 13, 2021, from
https://smj.org.sa/content/36/4/399.
● https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515446/
● Oral medication for the treatment of women with
gestational diabetes. (n.d.). Retrieved October 13, 2021,
from https://www.cochrane.org/CD011967/PREG_oral-
medication-treatment-women-gestational-diabetes.
● Required Textbook :Murray,s.,McKinny,E,
(2013(.Foundation of Maternal-Newborn Nursing.(5th
Ed ).saunders

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Gestational Diabetes

● Define gestational diabetes Mellitus

Name of the Patient: Sajedah

Diagnosis: SVD, laceration sutured , ebl 250 ml

Past medical history: Had regular menstruation. Not diabetic or hypertensive

1 day post-partum – findings

1. Hgb: 9.2 gm/dl (12.0 to 15.5 gm/dl)

Oral glucose tolerance test:

Glucose challenge test:

Drug class: Vitamin (type of vitamin B)

Function:Help in reduce the risk of neural tube defects

Patient perception of illness

She feels that she will deliver the baby

Nursing Care Plan

After half of -Allow mother to ask The goal is

After 2 days of 1- Instruct the client about The goal is

Definition Of gestational diabetes mellitus:

Gestational diabetes mellitus (GDM) is a

family history of type 2

previous pregnancy history vascular disease

There is highly incidence of developing type 2

5- future diabetes: mother 4-Birth injury to maternal

Gestational Diabetes Management

Diet ; for food affected by GDM. It should provide diet, nutrition

Gestational Diabetes Management

Blood Glucose Monitoring ;

Fetal Surveillance: Testing to identify fetal compro mise may begin as

Gestational Diabetes Management

Therapeutic Management includes oral anti-diabetic

- List some of the factors that can lead to

- How can we manage the GDM ?

Methods: We systematically searched PubMed, Ovid, Scopus

Results: Eighty-four studies with STROBE score ≥ 14 were included in

Conclusion: We found a high prevalence of GDM among the

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