Diabetes in Pregnancy: In a Nutshell (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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    00:01 So, first, gestational diabetes is defined as any degree of glucose intolerance that we first recognized during pregnancy.

    00:10 Ethnic background.

    00:12 So someone who is of African American descent, someone who is Latina, are going to be at increased risk for gestational diabetes.

    00:21 Also being over the age of 25, a history of obesity, or a previous obstetric history of a fetal loss or stillborn, or macrosomia.

    00:30 Family history, polycystic ovarian syndrome, multiple gestation or previous macrosomia are also going to be risk factors.

    00:38 The diabetogenic effect refers to the increase of insulin production and the simultaneous increase in insulin resistance that might be experienced during pregnancy.

    00:49 And remember, this is physiologic, so it's pretty normal.

    00:53 Potential maternal complications for gestational diabetes include: preeclampsia, polyhydramnios, weight gain, DKA, and hypoglycemia.

    01:04 So now let's talk about the potential fetal complications.

    01:07 So remember, Cletus is still inside.

    01:10 They include macrosomia, stillbirth or hyperglycemia, prematurity, Intrauterine Growth Restriction (IUGR), congenital anomalies, or cardiomyopathy.

    01:24 Potential newborn complications after the baby comes out include hypoglycemia, respiratory distress, polycythemia, jaundice, birth injury, hypocalcemia, hyperthermia, glucose intolerance and obesity.

    01:41 Gestational diabetes is diagnosed usually after 24 weeks.

    01:45 That's how long it takes for that diabetogenic effect to set up, and it's done using a two step method.

    01:51 Step one, a 50 gram dose of sugar is given orally, followed by a glucose tolerance test, which is usually a serum draw an hour later.

    02:01 A lab value of 140 milligrams per deciliter would indicate a positive screen.

    02:08 A three hour diagnostic test is indicated for someone who does have a positive screen.

    02:14 And during the three hour test, a fasting blood sugar is taken followed by a 100 gram dose of glucose.

    02:22 And then the serum is drawn at hour one, hour two, and hour three.

    02:27 If we have two or more of those for blood sugars, then that's considered a positive diagnosis.

    02:34 Exercise and nutrition are usually sufficient to manage gestational diabetes.

    02:39 However, if a persistent elevation in glucose is noted, then medication will absolutely be needed.

    02:47 The fetus should also be monitored throughout pregnancy.

    02:50 And during the labor, the nurse should monitor the client's blood sugar at least every two hours.

    02:56 The newborn should be checked for signs of hypoglycemia.

    03:01 So the newborn should be checked for signs of hypoglycemia, and it may present as jitteriness or poor feeding.

    03:10 Clients who are taking insulin during pregnancy may not and usually don't need insulin in the immediate postpartum period.

    03:17 And finally, because of the risk for developing type 2 diabetes, clients who have gestational diabetes should absolutely have a follow up screen at the six week postpartum visit.

    03:29 That was a lot.

    03:31 But you did it.

    About the Lecture

    The lecture Diabetes in Pregnancy: In a Nutshell (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Diabetes in Pregnancy (Nursing).

    Included Quiz Questions

    1. Age greater than 25
    2. Family history
    3. History of pregnancy loss
    4. Infertility
    5. Age greater than 22
    1. High blood pressure
    2. Weight gain
    3. Hypoglycemia
    4. Hypotension
    5. Weight loss

    Author of lecture Diabetes in Pregnancy: In a Nutshell (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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