Jacinth Louise G.

Padernal FEBRUARY 2, 2024

BSN 2B GROUP 4 DELIVERY ROOM NURSING ROTATION
ASSIGNED TOPIC Gestational Diabetes Mellitus

Any degree of glucose intolerance with

DEFINITION onset or first recognition during
pregnancy.

The etiology of gestational

diabetes appears to be associated with
two factors: 1) a delayed response of beta
cells to glucose levels, or dysfunction of
the pancreas; and 2) a marked increase
in insulin resistance resulting from
released placental hormones.

ETIOLOGY In GDM, the primary hormone

linked to elevated insulin resistance is the
human placental lactogen. Prolactin,
corticotropin-releasing hormone, growth
hormone, and progesterone are additional
hormones linked to the onset of this
condition. These hormones also act to
promote insulin resistance and diabetes
during pregnancy.

Obesity, physical inactivity,

advanced maternal age, multiparous
status, a family history of type 2 diabetes
mellitus, Asian ethnicity, a prior
macrocosmic child, polycystic ovarian
PREDISPOSING FACTORS
syndrome, and previous pregnancy with
GDM are risk factors for gestational
diabetes mellitus (GDM). Pregnant
women who have these factors increased
their risk of GDM.

The body cannot produce the

additional insulin required during
PRECIPITATING FACTORS
pregnancy, which results in gestational
diabetes. Aside from the other changes
 like weight gain, the body produces
unique hormones during pregnancy.
Insulin resistance is the result of these
alterations, which impair the cells' ability
to use insulin. Gestational diabetes
occurs in pregnant women whose bodies
are unable to produce enough insulin in
the later stages of pregnancy.

During pregnancy, the placenta

releases a hormone known as the human
placental lactogen. The mother may
experience a reduction in insulin
sensitivity as a result of this hormone's
ability to cause changes and
modifications to the insulin receptors. The
cells that produce insulin in your
pancreas, then, can age and insulin
resistance can worsen with time. When
the pancreas can no longer make enough
insulin, it then leads to hyperglycemia.
PATHOPHYSIOLOGY (IF APPLICABLE)
The increased blood glucose levels
cause the pancreas to produce more
insulin in order to keep up with the body's
processing of the blood sugar.
Conversely, elevated maternal glucose
levels can pass through the placenta and
result in hyperglycemia in the fetus. The
hyperglycemia causes the fetal pancreas
to become active. The anabolic
characteristics of insulin cause fetal
tissues to grow more quickly, which
results in macrosomia.

Gestational diabetes mellitus

(GDM) manifests through various signs
SIGNS AND SYMPTOMS and symptoms, primarily characterized by
hyperglycemia with a blood glucose level
exceeding 120 mg/dL. Common
 indicators include polyuria, marked by
frequent urination, and polydipsia, which
refers to excessive thirst. Additionally,
polyphagia, or excessive eating, may be
observed, leading to noticeable weight
gain. The enlarged size of the uterus,
surpassing the typical dimensions for the
gestational stage, is another notable sign.
GDM can contribute to the development
of a large for gestational age baby (LGA),
and glycosuria, the presence of glucose
in the urine, may also be detected.
Furthermore, individuals with gestational
diabetes may experience hypertension,
adding to the array of symptoms
associated with this condition.

HGT/CBG: used to check blood sugar

levels four or more times a day and to
monitor the effectiveness of treatment
FBS (Fasting blood sugar): used as a
screening test for gestational diabetes
mellitus (GDM) and to monitor blood
sugar levels in patients with diabetes.
OGTT: a confirmatory test for GDM,
DIAGNOSTIC TEST: PURPOSES
having 4 samples to check.
OGCT: used to screen for GDM, and if the
test is positive, a standard oral glucose
tolerance test (OGTT) should be
performed to confirm the diagnosis of
GDM.
Post Prandial Test: determine amount of
glucose in the plasma after meals

High blood glucose level (HGT)

monitoring, routine insulin injections, and,
if required, hypoglycemic medications are
MEDICAL MANAGEMENT
all important parts of the medical
management of gestational diabetes
mellitus (GDM). Lifestyle modifications
 like daily exercise and medical nutrition
therapy are often part of the first
treatment for GDM. Patients must
regularly monitor their blood sugar levels
at home in order to make sure that the
glycemic targets are being reached.
Medical therapy, including insulin
injection, should be started if the glycemic
goals are not met with these approaches.
When lifestyle changes alone are not
enough to manage GDM, insulin is the
main medication used. It is safe for the
mother and the unborn child to consume
during pregnancy and helps control blood
glucose levels by promoting the uptake of
glucose into cells.

In some circumstances, a
cesarean section (C-section) may be
advised for women with gestational
diabetes mellitus (GDM) in order to lower
the risk of complications from the disease,
especially shoulder dystocia. A condition
known as shoulder dystocia occurs when
SURGICAL MANAGEMENT. (IF the baby's shoulder becomes lodged
APPLICABLE) behind the mother's pubic bone during
childbirth, potentially leading to harm for
both the mother and the child. But the
choice to perform a C-section is made
case-by-case, with consideration given to
a number of other factors, including the
baby's size, the mother's health, and the
status of labor.

Imbalanced Nutrition More than Body

Requirements related to Gestational
Diabetes Mellitus: The increased
3 NURSING DIAGNOSIS
nutritional requirements and possible
overconsumption of calories that may
arise from the body's inability to control
 glucose levels during pregnancy are
addressed by this nursing diagnosis.

Imbalanced Nutrition less than Body

Requirements related to Gestational
Diabetes Mellitus: This diagnosis
acknowledges the possibility that the
mother and fetus may not receive enough
nutrition due to the difficulties in
maintaining appropriate blood glucose
levels brought on by gestational diabetes.

Risk for Fetal Injury related to Gestational

Diabetes Mellitus: The possible harm or
complications that the fetus may
experience as a result of the mother's
gestational diabetes are highlighted in this
nursing diagnosis. This covers the
possibility of birth trauma, macrosomia
(large baby), and other unfavorable
consequences.

1. Monitor and Manage Blood Glucose

Levels
● Rationale: Regular monitoring and
management of blood glucose
levels are essential to prevent
complications for both the mother
and the baby

2. Manage Unstable Blood Glucose

10 NURSING CARE
Levels
● Rationale: Unstable blood glucose
levels can pose risks to both the
mother and the baby, and prompt
management is crucial to prevent
complications

3. Continuous Monitoring for

Complications
 ● Rationale: Continuous monitoring
is necessary to detect and prevent
potential complications associated
with GDM, such as uterine
contractions and preterm birth

4. Provide Dietary Guidance and

Personalized Meal Plans
● Rationale: Proper nutrition is
crucial for managing GDM and
maintaining stable blood sugar
levels.

5. Educate Patients on Self-Monitoring of

Blood Glucose
● Rationale: Patient education
empowers individuals to take an
active role in managing their
condition and promotes better
health outcomes

6. Educate on Postpartum Care

● Rationale: Educating patients on
postpartum care, including ongoing
monitoring for diabetes and the risk
of developing type 2 diabetes, is
essential for long-term health.

7. Promote Adequate Nutrition

● Rationale: Adequate nutrition,
including a diet high in dietary fiber,
is important for supporting
maternal and fetal health in GDM

8. Prepare for Hospitalization if Diabetes

is Not Controlled
● Rationale: Hospitalization may be
necessary if GDM is not
adequately controlled to monitor
for potential complications and
 ensure the well-being of the
mother and the baby

9. If ordered, administer insulin.

● Rationale: Ensure optimal glucose
management and improve
maternal and fetal outcomes in
GDM patients.

10. Collaborate with Healthcare

Professionals to Adjust Medication
● Rationale: Collaboration is
essential to ensure that
medication, such as insulin, is
adjusted as needed to control
blood sugar levels

REFERENCES
Kumar, P. (2023, April 23). Blood Glucose Monitoring - StatPearls. NCBI. Retrieved

February 2, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK555976/

Mensah, G. P. (2019, September 30). Guidelines for the nursing management of

gestational diabetes mellitus: An integrative literature review. NCBI. Retrieved

February 2, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918019/

Ren, X. (2022, July 14). Research on the Effect of Nursing Methods for Gestational

Diabetes Mellitus Based on Comprehensive Nursing Intervention. NCBI.

Retrieved February 2, 2024, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9303124/

Torres, R. (2023, August 8). Gestational Diabetes - StatPearls. NCBI. Retrieved

February 2, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK545196/