NOVEMBER 6, 2014

DIAGNOSTIC:
Glucola screening @ initial
visit, if result is (-)
re-check @24-28 wks.
1-hr (50g) OGTT: + if
>130-140mg/dl then do
3-hr (100g) OGTT: + if 2
results exceeds parameter.

SOPHIA SORIANO-CASTILLO

COMPLICATIONS
FOR MOTHER:

COMPLICATIONS
FOR BABY:

PROGNOSIS:

Type 2 DM later in
life.

LGA, hypoglycemic
after birth, obese in
childhood/later life.

Usually after birth, BG of

mother return to normal
level. However, GDM will
recur in future pregnancies.

Miscarriage
Birth defects

GESTATIONAL DIABETES MELLITUS

PATHOPHYSIOLOGY

RISK FACTORS:

Fetus maintenance:
Increase in placental
hormones, cortisol, and
insulinase.

Maternal age over 25 years, previous macrocosmic infant, previous

unexplained IUFD, previous pregnancy w/ GDM, strong immediate
family hx of Type 2 DM or GDM, obesity,
and fasting BG >140mg/dl or random BG >200mg/dl.

Hormonal changes aect

maternal pancreas d/t
insulin-antagonistic eects
to support energy demand

of mother, especially the

fetus.

Maternal pancreas still

produces insulin but not
enough to its demand.

CLINICAL MANIFESTATIONS:
HYPOGLYCEMIA (insulin shock) irritability, hunger, sweating,
nervousness, personality change, weakness, fatigue, blurred or
double vision, dizziness, HA, pallor, clammy skin, shallow RR, rapid
pulse
HYPERGLYCEMIA (ketoacidosis) polydipsia, polyuria,
polyphagia, N/V, abd. pain, constipation, drowsiness, acetone
breath odor, rapid RR, weak/rapid pulse.
MEDICAL INTERVENTION:

Increase in maternal insulin

resistance.

Insulin therapy
NURSING INTERVENTION:

Maternal blood increases

with glucose level.

+ GDM

Assess clients knowledge about path, s/sx, management of care.

Review s/sx of hypoglycemia or hyperglycemia.
Teach proper medical responses in the event of
hypoglycemia or hyperglycemia.
Teach calorie count in grams: unit. Teach insulin admin.
Encourage family members to participate with modified lifestyle
such as exercise and food preparation.
Hypoglycemic give 15g simple sugar; re-check BG in 15, eat
15g simple sugar if remains low. Call HCP
Hyperglycemic give IVF: NS or 1/2 NS. Check BG. Call!1 HCP.

NOVEMBER 6, 2014

SOPHIA SORIANO-CASTILLO

Reference
Deglin, J., Vallerand, A., & Sanoski, C. (2009). Davis drug guide
for nurses (12th Ed). Philadelphia, PA: F. A. Davis
Company.
Lowdermilk, D., Perry, S., & Cashion, K. (2014). Maternity nursing
(8th Ed). St. Louis: Mosby
Prater, D. (2013). RN maternal newborn nursing, Ed 9.0.
Assessment Technologies Institue

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