Diabetes and Pregnancy

Diabetes Mellitus
- An endocrine disorder characterized by complete or partial insulin deficiency
- Islet of Langerhaans decreased production of insulin
- Insulin lowers blood sugar level
o Binds to receptor site of cell to facilitate entry of glucose into the cell
- Affects 3-5% of all pregnancies
- Most frequently seen medical condition in pregnancy
Classification
Type I insulin-dependent DM
- Complete insulin deficiency
- Insulin injections are needed
- Occur early in life below the age of 30
- Juvenile DM; more common in pregnant women (15-49 reproductive age)
Type II NIDDM
- Partial insulin deficiency
- Requires oral hypoglycemic agents (OHA) teratogenic
- 30 to 40 above
- Insulin is given to pregnant women
Gestational DM
- Abnormal glucose metabolism that arises during pregnancy
- Onset during pregnancy but may or may not resolve after delivery usually
to type 2
Impaired Glucose Homeostasis
- Impaired fasting glucose (FBS) FPG 110-126 mg/dL
- Impaired glucose tolerance (OGTT) 140-200mg/dL
Gestational Diabetes
Risk Factors:
- Obesity
- Age over 25 years
- History of large babies (10 lbs or more)
- History of unexplained fetal/perinatal loss
- History of congenital anomalies in previous pregnancies
- History of PCOS
- Family history of DM
- High risk Native American, Hispanic, Asian
** Insert diagram

Effects to the Mother

- Hyperglycemia
- Hypoglycemia
- Glycosuria

- Polyuria
- Monilial infection
- Risk of pregnancy-induced hypertension
Effects on the Fetus
- Congenital anomaly (caudal regression syndrome)
- Macrosomia
- Hydramnios
- Intrauterine growth restriction
- Intrauterine fetal death
- Delayed lung maturity
- Neonatal hypoglycemia
- Neonatal hyperbilirubinemia
Assessment:
Maternal Screening
- Fasting plasma glucose >126 mg/dL
- Nonfasting plasma glucose >200mg/dL
- 50g glucose load 1 hour oral glucose challenge test
- 100g glucose load 3 hour glucose tolerance test
- Glycosylated hemoglobin (HbA1c)
Fetal Screening
- Maternal serum AFP
- Ultrasonography
- Non-stress test and biophysical profile
- Fetal activity
- Lung maturity studies
o L/S ratio
o Phosphatidyl glycerol
Nursing Management
- Education
- Nutrition
o Dietary caloric requirement 30kcal/kg of BW
o 1800-2400 calories divided into 3 meals and 3 snacks
o 20% CHON, 40-50% CHO, and 30% fat
o Reduced saturated fats and cholesterol
o Increased amount of dietary fiber
o Keep weight gain to approximately 25-30 lbs.
- Exercise
o Begin the exercise program before pregnancy to determine glucose
fluctuations and food can be adjusted
o Eat protein or complex carbohydrate snack before exercise to prevent
hypocgylcemia
o Maintain a consistent exercise program
o 30 minutes of walking everyday
- Insulin therapy
Type
Onset
Peak
Duration
Very short-acting
15-30 mins.
0.5-1.5 hours
4-5 hours
Short-acting
30 mins-1 hour
2-4 hours
6-8 hours
Intermediate
1-1.5 hours
8-12 hours
18-24 hours
Acting
Long-acting
4-8 hours
16-20 hours
30-36 hours
Short acting combined with an intermediate type
2/3 of the daily dose is given in the morning (30 mins before breakfast
2:1 ratio, intermediate to regular) then the remaining 1/3 in the
evening (1:1 ratio)
Blood glucose monitoring
o
o

Hypoglycemia

Causes
o Omission of meal/delayed meals
o Nausea and vomiting
o Overdosage of insulin
o Exercising at the peak action of insulin
Manifestations
o Cardinal signs: cold sweats, weakness, trembling
o Nervousness, irritability, pallor, increased HR
o Confusion and fatigue
Management
o Milk, crackers