Summary
Highlights
Gestational diabetes is a type of diabetes that occurs during pregnancy, typically in the second or third trimester. It arises due to insulin resistance influenced by pregnancy hormones, changes in maternal metabolism, and increased nutrient demands of the baby.
Risk factors are remembered by the acronym MAMA: Maternal age over 25, Overweight or obese (BMI >25 or >30), Macrosomia (previous baby >9 lbs), Multiple pregnancies, and a history of gestational diabetes or family history of diabetes.
Gestational diabetes involves three key players: pregnancy hormones (like human placental lactogen, estrogen, cortisol, progesterone) causing insulin resistance, changes in the mother's metabolic system leading to low insulin sensitivity, and the baby's increased growth demands. Normally, the body compensates by increasing beta cell size and number, but in gestational diabetes, this compensation is insufficient, leading to hyperglycemia.
For the mother, high glucose levels can lead to glucose in urine (increasing risk of UTIs and yeast infections), hypertension, preeclampsia, and increased risk of C-section. For the baby, excess glucose causes them to produce more insulin and grow larger (macrosomia), which can lead to hypoglycemia and respiratory distress at birth due to immature lungs.
Symptoms are similar to hyperglycemia, commonly known as the three Ps: Polyphagia (constant hunger), Polydipsia (excessive thirst), Polyuria (frequent urination), and Sugar in the urine. Other signs include fruity breath, dry mouth, and increased risk of UTIs and yeast infections.
Nursing care is summarized by SUGAR BABE: Screening at 24-28 weeks (one-hour oral glucose tolerance test, followed by a three-hour test if abnormal), Use of diet and exercise to manage blood glucose (sometimes insulin/oral meds like glyburide are needed), Glucose monitoring at home (fasting 70-95 mg/dL, one hour after meal <140 mg/dL), Assess urine for glucose and UTIs, Risk factors for Mama assessed, Blood glucose swings during and after labor (monitor closely, IV insulin/glucose if needed, watch for hypoglycemia in mom and baby postpartum), Adverse effects discussed, Blood glucose monitoring postpartum (6-12 weeks after delivery for a glucose test), and Educate about the importance of regular diabetic testing due to a 50% risk of developing type 2 diabetes later.