Diabetes in Pregnancy: Risk Factors (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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    00:01 Let's talk now about risk factors and we're speaking specifically of risk factors for gestational diabetes.

    00:07 So, obesity could be a risk factor.

    00:10 Hypertension, so someone with preexisting disease would be someone who would be at risk for developing gestational diabetes.

    00:18 A client over the age of 25, now you might be thinking to yourself, well, that doesn't sound really impressive.

    00:24 Now, let's think about working in maybe a teenage clinic where we have a lot of young parents.

    00:30 And so if we have a lot of young pregnant clients, they're not necessarily going to be at risk for gestational diabetes unless some of these other risk factors play in, so that would be important to know.

    00:40 If there's a family history of any type of diabetes, so, gestational diabetes or type 1 or type 2, then we want to pay attention to that.

    00:50 And also, if there's a significant OB history and when I say significant, I mean any history, of a stillbirth or fetal macrosomia.

    00:59 Macrosomia, meaning large body or big baby.

    01:02 So hold on to that when we talk about fetal effects, this is going to comeback, so remember that one.

    01:07 Other complications that the client might experience would be that they could develop preeclampsia.

    01:13 So why would that be? We've already talked about the fact that the placenta, for someone who has gestational diabetes is not exactly normal.

    01:23 And the hormones are overshooting and causing it some resistance, so that's already one problem.

    01:29 So if your placenta is not doing one job well, then there's a potential it could not do other jobs well, which may lead to the development of preeclampsia.

    01:39 Also, polyhydramnios.

    01:42 I'm hoping you remember your 3P's of diabetes, polyurea, polyphagia, and polydipsia.

    01:48 So polyphagia where you eat a lot, well, you're not going to see the baby doing that cuz well, they don't really eat so that doesn't really work, and then being thirsty.

    01:58 Again, babies don't really do that so much. But, let's talk about the third P.

    02:04 Polyurea, hmm, a lot of urine. How would that be a complication? Well, let's think about it. What is the amniotic fluid made of? And if you don't know the answer to this, I'm getting ready to gross you out because mostly it's made up of fetal urine, you got it.

    02:22 So when you think about producing excessive urine, or polyurea, then it makes sense, the baby is not a diabetic, and all that extra glucose from the pregnant person's blood stream comes into their bloodstream and oh, my, goodness, their blood sugar goes up and they experience those 3P's as well, so they void a lot and the amniotic fluid increases to the point where we have polyhydramnios.

    02:50 Weight gain. So this again is going to be a pregnant person sign.

    02:54 Maybe a baby's sign too but we'll talk about that in just a minute.

    02:58 Diabetic ketoacidosis, we just talked about what that looks like and because the body is trying to regulate these blood sugars, there may actually be episodes of hypoglycemia for the pregnant person as well.

    03:11 Let's talk about some more of those potential fetal complications.

    03:16 So, remember all that glucose that's being transferred between the pregnant person and the baby, it's coming through the placenta and the baby is just eating it up more and more calories and they're getting fatter and fatter and fatter, and I don't mean in the cute kind of fat, I mean the kind of fat and the kind of macrosomia that can lead to birth injuries, okay? Also, if the baby's blood sugar is really high, they can go into a coma as a result of hyperglycemia which can ultimately lead to stillbirth. Is that coming back to you now? Yes. Very good.

    03:53 Now, one of the ways that we treat diabetes is that we get the baby out of that environment, so they may need to be delivered early, so prematurity is definitely a possibility when we think about complications.

    04:06 Now with preexisting disease, one of the things that having abnormally high blood sugars can do is it can change the DNA of your cells which could lead to congenital anomalies, especially if blood sugars are out of control during those first eight weeks.

    04:22 Remember, that's when we have the formation of organs, so that's really important.

    04:27 We can also have situations where, because we have damage to vessels, we could develop heart disease or cardiomyopathy.

    04:35 That's also a symptom of preexisting disease, but it can happen as a result of gestational diabetes as well.

    04:41 So now let's talk about what happens to that sweet little baby when they come out? So remember, the baby's been in there chilling, gobbling up all that glucose, because they're not a diabetic and their beta cells produce all the insulin that is needed to get that glucose into the cell.

    04:59 So where is that glucose coming from? It's coming from the pregnant person and it's coming through that placenta, and once the baby's born and we cut the cord, then that connection is lost and so now, the insulin has used up all the glucose and what happens to the blood sugar? Well, it goes down and now we have an infant with hypoglycemia.

    05:22 Well, I tell you this thing about babies, they're really not good at multitasking.

    05:27 So when one thing goes bad, lots of things go bad.

    05:31 So we start with hypoglycemia, then as the baby tries to regulate that temperature, well, they don't do so well with that either, then they develop hypothermia, so they're cold.

    05:42 Well, then, when that happens, then there's respiratory distress, and they don't breathe very well.

    05:48 Well, then, the next thing that happens is that the body tries to produce more red blood cells to get more oxygen, we overshoot and then the baby develops jaundice.

    05:58 And, then, when we think about the macrosomia, large body, remember I said, not cute kind of fat but birth injury kind of fat? Let's think about the baby trying to come out and we have this nice big linebacker head that comes out and this nice big linebacker shoulders from all that fetal macrosomia, and then we have a shoulder that keeps the baby's body from delivering and we have a shoulder dystocia.

    06:23 So now we have an injury, potentially, on the brachial plexus, because we had a big baby.

    06:28 See how all this sort of stacks together? Then we can have issues with glucose intolerance, again, because we had respiratory distress and hypothermia, and all of those other issues, then the baby can have trouble managing their blood sugar.

    06:43 And then, as the infant gets older, remember our long term consequences? Obesity could definitely be there and you just fill in the blank on all the potential life-long complications that can result from that.

    About the Lecture

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

    Included Quiz Questions

    1. Polyhydramnios
    2. Dysuria
    3. Hunger
    4. Oligohydramnios
    1. Obesity
    2. Hypertension
    3. Client older than 25
    4. Client older than 38
    5. Hypotension
    1. Weight gain
    2. Maternal hypoglycemia
    3. Pre-eclampsia
    4. Weight loss
    5. Hypotension
    1. Macrosomia
    2. Prematurity
    3. Cardiomyopathy
    4. Low weight

    Author of lecture Diabetes in Pregnancy: Risk Factors (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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