Gestational

diabetes
mellitus
Women and Newborn health nursing (NURSE 419)

Instructors :
ms. Hannah Deva Priya
Ms. Fralyn Abellanosa
Gabuya
Ms. Rawan Abdullah
 team work
Wadha Alholibi 391230-
555 Renad almubarak
391230-538 Fatimah
almosalam 391230-539
Zahraa Almajhed 391230-
537
1. Case scenario:
Patient history
Patient
assessment
Laboratory and diagnostic
investigations Medications
Patient's perception of her
illness Nursing care plan

1. DISEASE CONDTION:
Definition of Gestational diabetes mellitus
Incidence and risk factors
Clinical manifestation Complication for the mother
and baby
Management
Evidenced based practice
References
Outlin
e:
 Patient history:
Name of the Patient:
Sajedah Age:38 years
Married: non-
Sajedah...
consanguineous
Husband: works as
.
engineer
Diagnosis: SVD, laceration sutured , ebl 250 ml ,Gestational diabetes
Mellitus
Past G2 P1
medical @ 39weeks
history: of gestation
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: : Uncleis 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(Shortness of breath).
Lab 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
 The Glucose
Challenge Test
&
The Oral Glucose
Tolerance Test
 The Oral Glucose
Tolerance Test
This test show if you at risk of having diabetes or
already have it .the test is done if you ; The test is shorter during pregnancy. You'll be
1.overweight,
given a sweet liquid to sip. After that, you'll
2.have a diabetic near
undergo a blood test in around 60 minutes.
family, 3.Have high blood
pressure, Two hours after you finish the glucose drink,
4.Delivered a baby weighing more than 9 this is the result mean
pounds 5.Have had gestational diabetes during Normal blood sugar level is less than 140
a previous mg/dL.
pregnancy.
Between 140 and 199 mg/dL impaired
How prepare for the test: glucose tolerance or prediabetes;
Eat about 150 grams of carbohydrates each day for 200 mg/dL or higher diabetes
three days to obtain an accurate OGTT reading . To
test your initial blood sugar level, the nurse will take A blood glucose level of 140 mg/dL or
a blood sample from a vein in your arm.
above is considered abnormal when
you're pregnant.
 The glucose challenge test, or one-hour glucose tolerance test, measures your body's response to
sugar. It is done during pregnancy to screen for gestational diabetes

The The test is carried out in two stages. You start by drinking a sweet solution. Your blood sugar
level is checked an hour later. The results will tell you if you have gestational diabetes
or not.
Glucose If you're at an average risk for gestational diabetes, you'll most likely be tested during your
second trimester, between 24 and 28 weeks.
If you're at high risk for gestational diabetes, your doctor may suggest that you get screened as

Challen soon as your first prenatal visit. The following are some possible risk factors:

Being or having a body mass index of 30 or higher

ge Test (obesity) lack of physical activity.

A previous pregnancy with gestational diabetes

Normal range for pregnancy : Fasting <5.3 mmol/L. 1 hour after a meal <7.8
mmol/L
Medicatio
ns Tab . Folic acid (5mg) daily
Drug class: Vitamins
function:
preventing and treating low blood levels of folate
(folate deficiency) and high blood levels of
homocysteine (hyperhomocysteinemia).
during pregnancy:
to prevent serious birth defects such as spina bifida
side effects:
Nausea, loss of
appetite bloating, gas,
stomach pain
sleep
problems
depression;
feeling excited or irritable
Patient perception
of illness:
She feels that she will deliver the

baby and anxious about the blood

glucose sugar.
Nursing Care
Plan
Patient verbalized “I
have a pain “
Gestational
diabetes
mellitus
(Gestational diabetes mellitus (GDM

is defined as any degree of glucose

intolerance with onset or first recognition
during pregnancy
 1.Overweight and risk
obesity.
2.A lack ofgestational
3.Previous factors
physical diabetes or
activity. 4.Polycystic ovary
prediabetes.
syndrome.
5.Diabetes in an immediate family member.
6.Previously delivering a baby weighing more than
9
pounds (4.1 kilograms).
7.Race — Women who are Black, Hispanic,
American Indian and Asian American have
a higher risk of developing gestational
diabetes.

obesity and maternal age are the two most

important factors independently affecting the
risk of gestational diabetes mellitus (GDM)
 Incidenc
e
Saudi Arabia is among the top ten countries in the world with the highest prevalence of diabetes [, ].
Arecent report from Saudi Arabia estimated the prevalence of pregestational diabetes mellitus (Pre-
GDM) and gestationaldiabetes mellitus (GDM) in Riyadh, the capital city of Saudi Arabia, to be .% and.
%, respectively []. isprevalence reects high burden of diabetes among pregnant women compared to
other populations in the world [, ].Pregnancies complicated by maternal diabetes are associ-ated with
adverse maternal and neonatal outcomes including increased rate of Cesarean section delivery,
macrosomia, admission to neonatal intensive care unit (NICU), and peri-natal mortality [, ]. Interventions
such as preconception care for women with pre-GDM and screening and control of hyperglycemia
during pregnancy for women with GDM have been proven to improve the outcomes for
pregnancies complicated with diabetes.
 Incidenc
e
Middle East and North Africa
had the highest
prevalence of GDM with a median
estimate of 12.9 % (range
8.4–24.5 %), followed by Southeast
Asia, Western Pacific,
South and Central America,
Africa, and North America and
Caribbean (median prevalence 11.7, 11.7,
11.2, 8.9, and
7.0 %, respectively), whereas
Europe had the lowest
prevalence (median 5.8 %;
range 1.8–22.3 %) (
 Fatigue Clinical
Dray mouth (xerostomia)
Blurred vision ( sharpness of vision) manifestations

Increased, frequent urination

(Polyuria) Thirst increases
(Polydipsia)
Vision become cloudy
(Cataracts)
Infection caused by yeast
Weight loss even with increased appetite
 Complication of
gestational diabetes
on
the mother and baby
 Complication may affect baby if the
mother have gestational
diabetes :

Excessive birth
macrosomi weight(fetal
a Obesit
macrosomia)
Early (preterm) birth.
y
Serious breathing
difficulties. hypoglycemia
Obesity and type 2 diabetes
later in life
Stillbirt breathing Stillbirth( death or loss of a
h difficulties baby before or during
delivery)
Complications that may affect the
mother :

High blood pressure

and preeclampsia
Having a surgical
delivery (C-section)
Future diabetes.
Patient education

Medical Nutrition
therapy;A healthy diet

Glycemic monitoring; Check the blood

sugar level every 2-5 hours

Pharmacological therapy; ,usually

metformin or insulin injections

Fetal monitoring: ultrasound at around week 18

to 20 of your pregnancy to check your baby for
abnormalities. Managemen
Exercise
Planning on delivery t
Evidenced based practice
An interesting
Video
Reference:
1-Mayo Foundation f or Medical Education and Research. (2020, August 26).
Gestational diabetes. Mayo Clinic. Retrieved October 11, 2021, from h t t p s : / /
www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/
syc-20355339.
2-American Diabetes Association. (2003, January 1). Gestational diabetes mellitus.
Diabetes Care. Retrieved October 11, 2021, from https://care.diabetesjournals.org/

. Thank
cont ent / 2 6/ suppl_1/ s1 0 3
3-Gestational diabetes ,Date accessed. (October 11, 2021) , Date published .
(August 26, 2020). https://www.mayoclinic.org/diseases-conditions/gestational-

you
For
diabetes/symptoms-causes/syc-20355339
4-WebMD. (n.d.). Oral glucose tolerance test f o r Gestational &amp; Type 2 diabetes.
WebMD. Retrieved October 15, 2021, from
https://www.webmd.com/diabetes/guide/ oral-glucose-tolerance-test.
5-Mayo Foundation f o r Medical Education and Research. (2021, September 8). Glucose

listening
Challenge Test. Mayo Clinic. Retrieved October 15, 2021, from h t t p s : / /
www.mayoclinic.org/tests-procedures/glucose-challenge-test/about/pac-20394277
.
6- Required Textbook :Murray,s.,McKinny,E,(2013(.Foundation of Maternal-
Newborn Nursing.(5th Ed ).saunders,ch26,p654,655,656