Gestational Diabetes Lecture Notes

Introduction

• Gestational diabetes is a form of diabetes occurring during pregnancy, usually in the second or third trimester.
• After the lecture, a quiz is available to test your knowledge.

Risk Factors (MAMA Mnemonic)

• M: Maternal age over 25
• O: Overweight (BMI > 25) or Obese (BMI > 30)
• M: Macrosomia (previous baby > 9 pounds)
• M: Multiple pregnancies
• A: A history of gestational diabetes or family history of diabetes

Pathophysiology

• Three Key Players:
  1. Pregnancy hormones: influence insulin sensitivity.
  2. Mom's metabolic changes: decreased insulin sensitivity.
  3. Baby's growth: requires more glucose.
• Diabetes involves issues with insulin, which helps cells absorb glucose from the blood.

Types of Diabetes

• Type 1 Diabetes: Autoimmune, beta cells not functioning, no insulin production.
• Type 2 Diabetes: Insulin resistance, cells don't absorb glucose effectively.
• Gestational Diabetes: Similar to Type 2, occurs during pregnancy, often resolves post-birth.
  • 50% risk of developing Type 2 diabetes later.

Insulin and Pregnancy

• Insulin sensitivity is high early in pregnancy, aiding in growth.
• Later pregnancy: decreased sensitivity to provide more glucose to the baby.
• Hormones like human placental lactogen, estrogen, cortisol, and progesterone influence insulin sensitivity.

Consequences of Gestational Diabetes

• For Mother: Hyperglycemia, risk of urinary tract infections, yeast infections, hypertension, and preeclampsia.
• For Baby: Large size (macrosomia), risk of hypoglycemia at birth, respiratory distress.

Signs and Symptoms of Gestational Diabetes

• Three P's:
  • Polyphagia: constant hunger
  • Polydipsia: excessive thirst
  • Polyuria: frequent urination
• Sugar in urine, fruity breath, dry mouth, risk of infections

Nurse's Role and Treatment (SUGAR BABE Mnemonic)

• S: Screening for gestational diabetes (24-28 weeks gestation)
  • One-hour oral glucose test, followed by a three-hour test if needed.
• U: Use diet and exercise to manage blood glucose.
• G: Glucose monitoring during fasting and post-meal periods.
• A: Assess urine for glucose, check for urinary tract infections.
• R: Risk factors for assessment.
• B: Blood glucose swings monitoring during and after labor.
• A: Adverse effects monitoring (preeclampsia, hypertension, infections).
• B: Blood glucose monitoring postpartum (6-12 weeks).
• E: Educate on the risk of developing Type 2 diabetes and the need for regular testing.

Conclusion

• Gestational diabetes is a serious condition with implications for both mother and baby.
• Awareness, monitoring, and management are critical for healthy outcomes.