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A 29-year-old G4P2 Hispanic woman, with a history of gestational...

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Palm Beach State College

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SCIENCE / -RSPT

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SCIENCE /

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A 29-year-old G4P2 Hispanic woman, with a history of gestational diabetes mellitus (GDM), presents to her
OB/GYN office for a routine prenatal visit at 24 weeks' gestation. Her physical examination is unremarkable,
and her fetal well-being is reassuring. Because of her previous history of GDM, she is at high risk of
developing GDM during this pregnancy and the doctor recommends a glucose challenge test, which is the
most common method of screening for GDM. Test results reveal that her 1-hour glucose loading test (GLT) is
179 mg/dL (normal value <140 mg/dL). Because her GLT value is high, she then undergoes a 3-hour glucose
tolerance test (GTT), which is used for a definitive diagnosis of GDM. The patient is positive for GDM when all
of her plasma glucose values are elevated. Treatment recommendations include beginning a diabetic diet,
participating in moderate exercise sessions three times a week, daily home glucose monitoring, and weekly
antepartum visits to monitor glycemic control. The doctor explained to the mother that GDM poses little risk to
her at this
time; however, it is associated with an increase in infant birth trauma and perinatal morbidity and mortality with
the risk to her fetus directly related to its size. The goal of antepartum treatment of GDM is to prevent fetal
macrosomia, which is defined as an estimated fetal weight of ⩾ 4500 grams, and its resultant complications by
maintaining desirable maternal blood glucose levels throughout gestation. It was explained that if diet alone
did not maintain blood glucose at desirable levels, then hypoglycemic therapy with insulin injections given
several times a day may be required.

1. Why was this patient considered to be at high risk for GDM and tested at 24 weeks' gestation?
2. Who is at greatest risk when the mother has GDM?
3. What are two testing methods for GDM?
4. What is the primary treatment for GDM?

SCIENCE HEALTH SCIENCE NURSING SCIENCE / RSPT

Answer & Explanation

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Rated Helpful

Answered by lucianashuma

1. Why was this patient considered to be at high risk for GDM and tested at 24 weeks' gestation?
She was considered to be at high risk for GDM because she had history of GDM with the previous pregnancy
and at 24 week gestation is when mothers most likely start developing GDM complications like fetal
macrosomia.
It is usually associated with Maternal complications consist of hypertension, preeclampsia, increased risk of
cesarean delivery, and development of diabetes mellitus after pregnancy. Therefore catching it at this period
can help prevent these complications.

2. Who is at greatest risk when the mother has GDM?

Both the mother and the baby because of the complications that could arise for both of them but more on the
mothers side. The baby can develop fetal macrosomia which can cause birth trauma and severe postpartum
hemorrhage. She can also develop severe complications like eclampsia and preeclampsia which are
associated with increased mortality. She can also develop lifetime diabetes mellitus after the pregnancy with
its many systemic complications.

3. What are two testing methods for GDM?

These include the following :
1-hour glucose loading test (GLT)

3-hour glucose tolerance test (GTT)

4. What is the primary treatment for GDM?

Primary treatment of GDM Is administration of hypoglycemic medication which may include oral hypoglycemic
medication like metformin or use of insulin depending on the gestation of the pregnancy.
NOTE - However oral hypoglycemics apart from metformin are associated with an increased risk of
developing congenital malformations duting the pregnancy.
Secondary treatment include proper diet and exercise and monitoring of the blood glucose levels.

Step-by-step explanation

Fetal complications of GDM include

macrosomia

neonatal hypoglycemia
 polycythemia

increased perinatal mortality

congenital malformation

hyperbilirubinemia
respiratory distress syndrome

hypocalcaemia

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