Diabetes in Pregnancy: In a Nutshell (Nursing)

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.