Gestational Diabetes Mellitus (GDM)

Overview

Gestational diabetes occurs when the body cannot produce enough insulin to overcome the insulin resistance caused by placental hormones. This condition usually develops in the second half of pregnancy and often resolves after delivery. Management is crucial to prevent fetal macrosomia and neonatal metabolic complications.

Key nursing concepts

• Gestational diabetes mellitus (GDM) is caused by placental hormones causing insulin resistance.
• Poorly controlled GDM increases the risk of preeclampsia and Cesarean delivery.
• The target for fasting blood glucose is generally below 95 mg/dL.
• Fetal hyperinsulinemia in utero can lead to neonatal hypoglycemia after birth.
• Diet and exercise are the first-line treatments for GDM.
• Glyburide or insulin may be used if lifestyle changes do not achieve euglycemia.

Important nursing considerations

• Monitor blood glucose levels closely as insulin needs change throughout pregnancy.
• Perform a one-hour glucose tolerance test between 24 and 28 weeks of gestation.
• Monitor fetal growth via ultrasound for signs of macrosomia (large for gestational age).
• Assess the newborn for hypoglycemia immediately after birth.
• Encourage a consistent diet and exercise plan to maintain glycemic control.
• Observe for signs of ketoacidosis, which is a medical emergency for mother and fetus.

Patient teaching

• Instruct the patient on the correct technique for self-monitoring of blood glucose.
• Discuss the importance of tracking carbohydrate intake and maintaining a meal schedule.
• Encourage postpartum follow-up glucose testing at 6 to 12 weeks.

Related practice questions

Real questions from the NursGuru bank, each with the answer and rationale.

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Gestational Diabetes Mellitus (GDM) flashcards

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