PREGNANCY

Late gestation

Adipose Tissue accretion

Formation of the placenta

Increased levels of resistin Adipose tissue depot decline Obesity FFA increases Increased cortisol, estrogen and progesterone Insulin mediated glucose disposal worsens Interferes with post insulin receptors Ethnicity

Stimulation of placenta for hormonal production

Increased production of hCG

Placental insulinase

Increased HPL and hPGH

Accelerates insulin degredation

Decreased peripheral resistance to insulin

Decreased tissue sensitivity To insulin

Family Hx Pancreas produces more insulin to compensate

Exercise

Age

Fails to compensate or produce enough insulin

Glucose remains in the blood

1.

NCP Trauma, Risk for Injury related to presence of macrosomia or IUGR. Risk for maternal Injury related to inadequate diabetic control secondary to Gestational Diabetes. Anxiety related to situational crisis/ threat to health status (maternal or fetal) secondary to Gestational Diabetes. Risk for impaired parent/infant / child attachment related to Interruption in bonding process, physical illness/changes in physical abilities secondary to Gestational Diabetes. Knowledge deficit regarding condition, prognosis and treatment needs related to lack of exposure, misinterpretation of the disease process secondary to Gestational Diabetes.

Energy depletion on body cells

Increased blood glucose concentration

Crosses placental barrier and enters the fetus

2.

Oxidation of fats and protein

Increased glucose levels Osmotic pressure pulls H2O from cells to blood Increased insulin production Cellular dehydration Fetal hyperinsulism and hyperglycemia Glycosuria Polydipsia Macrosomia Polyuria Preterm Birth
5. 3.

Wasting of muscle fats and protein

4.

Prevents H2O reabsorption in the kidney tubules

Weakness

Fatigue Disease process Risk Factor Manifestation CS

Hypoglycemia