Gestational Diabetes

Mellitus
Maternity Nursing Jigsaw
 Group Member

01 02 03
Dian Novita Jonathan Puji Mutiara
Sari
I1B020035
H
I1J020009
Romadhon
I1B020040

04 05
Nur Aljananti Yusmita Puji L
I1J020004 I1B020013
Key Questions That Must Be Solved (Case
4):
1. Explain the prevalence, classification/type of Gestational Diabetes Mellitus!
2. Explain the etiology and factors of Gestational Diabetes Mellitus!
3. Describe the clinical manifestations of Gestational Diabetes Mellitus!
4. Explain the pathophysiology of Gestational Diabetes Mellitus!
5. Explain the management of Gestational Diabetes Mellitus!
6. Explain the assessment, nursing diagnoses that may arise, and nursing
interventions in Gestational Diabetes Mellitus!
 Explain the prevalence, classification/type of
01 GDM
Diabetes mellitus (DM) is an endocrine disorder of carbohydrate metabolism,
resulting from inadequate production or use of insulin. In general, diabetes is classified as
type 1 (insulin deficient) or type 2 (insulin resistant, with a relative deficiency of insulin
to metabolize carbohydrates. Meanwhile, gestational diabetes mellitus (GDM) is defined
as diabetes diagnosed in the second and third trimesters of pregnancy. According to
Gandhi et al. (2018) GDM has emerged as a global public health concern. It is associated
with short-term and long-term adverse effects on both mother and newborn. Decreased
quality of life and increased risk of cesarean section, gestational hypertension,
preeclampsia, and type 2 diabetes are some additional risks that can be experienced by
GDM patients. Not only in the mother, GDM can also cause macrosomia (baby size
larger than normal gestational age), neonatal hypoglycemia, and type 2 diabetes mellitus
in the future.
 01 Explain the prevalence, classification/type of
GDM

The global prevalence of GDM varies widely, from 1% to 28%,

depending on population characteristics (e.g., maternal age,
socioeconomic status, race/ethnicity, or body composition), screening
methods, and diagnostic criteria. And the continent with the largest
population prevalence of GDM in the world is Asia (60% of the
world's population).
 02 Explain the etiology and factors of perinatal
GDM

GDM occurs in about 7% of all pregnancies in the United States. A high risk of GDM is
experienced by women who have obesity, glycosuria, or a family history of diabetes. The diagnosis
of GDM is very important because it is associated with an increased risk of perinatal morbidity and
mortality even in mild stages. In addition, GDM can also develop into real type 2 DM if not treated
properly.
The known risk factor of GDM are: ● Hypertension or preeclampsia in the current
● Advanced age (≥35 years) pregnancy
● Overweight or obesityMercury ● History of recurrent miscarriage
● Excessive gestational weight gain ● Offspring malformation
● Excessive central body fat deposition ● Fetal or neonatal death
● Family history of diabetes ● Macrosomia (condition in which a fetus is
● Short stature (<1.50m) larger than average)
● Excessive fetal growth ● GDM during prior pregnancy
● Polyhydramnion ● Polycystic ovary syndrome
 03 Describe the clinical manifestations of GDM!

If the body is unable to respond to insulin appropriately, high levels of sugar

build up in the bloodstream and cause the symptoms of diabetes. Gestational
diabetes can potentially cause some health risks to both the pregnant woman and
the fetus. These health risks include:
● Higher birth weight of the baby
● premature birth
● low blood sugar levels in the baby at birth
● an increase in the pregnant woman’s blood pressure
● a higher risk of the woman developing preeclampsia during pregnancy
Gestational diabetes typically goes away following pregnancy. A doctor will
check the woman’s blood sugar levels shortly after delivery and then again within 6
weeks.
 Gestational diabetes may not present any obvious signs or symptoms, as
many of the changes can be similar to those that occur during pregnancy.
However, possible signs and symptoms include:
● Fatigue
● Blurred vision
● Extreme thirst
● Nausea
● Frequent bladder, vaginal, or skin infections
● Frequent urination
● Sugar in the urine
Any woman experiencing new or unusual symptoms during pregnancy
should speak to her doctor. The doctor may be able to determine whether she
has developed gestational diabetes or any other condition.
 Explain the pathophysiology of GDM !
04
In patients with DMG insulin response is consistently reduced to the supply of nutrients. A
number of pancreatic -cell function defects were also found in women with a history of GDM; The
majority of DMG patients experience -cell dysfunction due to chronic insulin resistance before
pregnancy. Defects in insulin binding to its receptors in skeletal muscle are not the cause of insulin
resistance in women with GDM. Many other defects such as impaired insulin signaling, reduced
PPARγ expression, and reduced insulin-mediated glucose transport have been found in skeletal muscle
or fat cells in women with GDM. Among the defects above, the primary or fundamental cause of the
insulin action defect in GDM is not known for certain.
Recent findings suggest a post-receptor defect in insulin signaling pathways in the placentas of
diabetic and obese pregnant women. Other findings suggest that impaired postreceptor insulin
signaling under maternal regulation is selective and unregulated by the fetus. Recent findings indicate
that the conditions that cause GDM are triggered by fetal self-antigen loading. The interaction between
human leukocyte antigen-G (HLA-G) and nuclear factor-kB (NF-kB) is indicated as a cause of GDM.
Diabetes mellitus in patients undergoing organ transplantation is thought to be analogous to the
occurrence of GDM in pregnancy.
 05 Explain the management of
GDM!
Management of patients with GDM include:
1. Diet therapy
Women with diabetes need to be aware of how much carbohydrate they eat daily by
estimating the total carbohydrate each meal. A 1,800- to 2,400-calorie diet (or one calculated
at 30 kcal/kg of ideal weight), divided into three meals and three snacks to try and keep
carbohydrates evenly distributed during the day so the glucose level remains constant. In
addition, a woman’s diet should be certain to include a reduced amount of saturated fats and
cholesterol and an increased amount of dietary fiber. Increasing fiber decreases postprandial
hyperglycemia and so lowers insulin requirements. Women are extremely vulnerable to
hypoglycemia at night during pregnancy because of the continuous fetal use of glucose
during the time they sleep. Urge a woman to make her final snack of the day one of protein
and a complex carbohydrate (e.g., an egg and whole grain toast, hummus and whole grain
crackers) to allow slow digestion during the night.
2. Exercise
With exercise, blood glucose levels decrease because the muscles increase their need for
glucose, an effect which lasts for at least 12 hours after exercise. a woman should eat a snack
consisting of a protein or complex carbohydrate before exercise and should maintain a
consistent exercise program—she should not do aerobic exercises one day and then none the
next, but rather, do 30 minutes of walking every day. In a woman with poor blood glucose
control, extreme exercise will cause hyperglycemia and ketoacidosis as the liver both releases
glucose and breaks down fatty acids in an attempt to supply enough energy for the exercise,
yet the body cannot use them because of inadequate insulin.
3. Glycemic control
Completed four times a day by the patient. The patient pricks her finger and uses a glucometer to
determine her blood glucose. She should track these numbers with a chart and bring it to her OB
visits. Her provider will determine if any adjustments in her insulin or oral diabetic regimen are
needed. Patient glucose target DMG by using samples capillary blood is:
a. Preprandial (after fasting) <95 mg/ dL (5.3 mmol/L)
b. 1 hour postprandial (after eating) <140 mg/dL (7.8 mmol/L)
c. 2 hours postprandial (after eating) <120 mg/dL (6.7 mmol/L)
4. Insulin therapy
insulin therapy considered when the glucose target plasma is not reached after
monitoring DMG for 1 - 2 weeks. Two thirds of daily insulin needs are given
before breakfast and one third before dinner. Insulin should be given
subcutaneously and at a 90-degree angle to the skin. The injection site should
generally be the same each injection (arms OR legs OR abdomen).

5. Oral hypoglycemic drugs

Drug oral hypoglycemics such as glyburide and metformin is an alternative
insulin replacement in treatment DMG.
 Explain the assessment, nursing diagnoses that may
06 arise, and nursing interventions in Gestational Diabetes
Mellitus!
Nursing Diagnosis
Risk for ineffective tissue perfusion
(peripheral) related to lowered blood
pressure secondary to mitral stenosis
and gestational diabetes.
Outcome
● BP returns to 120/70 mmHg;
● pulse rate at 70 to 90 beats/min;
● fetal heart rate at 110 to 160
beats/min.
● Serum glucose is less than 126
mg/dl;
● labor is halted.
Intervention
● Review with patients the need for
consistent diet and exercise to
regulate glucose during pregnancy.
● Monitor patient’s BP, pulse rate,
FHR, and uterine contractions by
continuous monitoring.
● Assure patient echocardiogram is
safe during pregnancy. Assist as
necessary.
● Educate patients about the need for
rest in lateral recumbent position
until condition is stabilized.
● Document pattern of blood glucose.
Administer intravenous (IV) fluid,
insulin additive as prescribed.
 Reference
● Egbe, T., Tsaku, E., Tchounzou, R., & Ngowe, M. (2018). Prevalence and risk factors of gestational
diabetes mellitus in a population of pregnant women attending three health facilities in Limbe, Cameroon:
a cross-sectional study. Pan African Medical Journal, 31. doi: 10.11604/pamj.2018.31.195.17177
● Gandhi, T., Kaplan, G., Leape, L., Berwick, D., Edgman-Levitan, S., & Edmodson, A. et al. (2018).
Transforming Concepts in Patient Safety: A Progress Report. Retrieved 26 September 2021, from
https://qualitysafety.bmj.com/content/qhc/27/12/1019.full.pdf
● Kurniawan, L.B. (2016). Patofisiologi, Skrining, dan Diagnosis Laboratorium Diabetes Melitus
Gestasional. CDK-246/ vol. 43 no. 11
● Ladewig, P.A., London, M.L. & Davidson, M.R. 2014. Contemporary maternal-newborn nursing care. 8th
ed. New Jersey; Pearson.
● Murray, S.S., McKinney, E.S., Holub, K. & Jones, R. 2019. Foundations of maternal-newborn and
women’s health nursing. 7th ed. St. Louis, Missouri: Elsevier
● Silbert-Flagg, J. & Pillitteri, A. (2018). Maternal & child health nursing: care of the childbearing &
childrearing family. Philadelphia: Wolters Kluwer
● Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018). The pathophysiology
of gestational diabetes mellitus. International journal of molecular sciences, 19(11), 3342.
Thank You