GESTATIONAL DIABETES

Gestational Diabetes

Table of Contents

Contents

Introduction3

Onset4

Symptoms & Complications5

Obesity and weight gain7

Diet7

Screening and diagnosis8

Perinatal outcomes8

Prevention9

Diagnosis10

Nursing Interventions in the Hospital10

Nursing Interventions outside the Hospital11

Postpartum12

References14

Gestational Diabetes

Introduction

Gestational diabetes mellitus has been defined as glucose intolerance of variable severity with onset or first recognition during pregnancy. Glucose levels usually return to normal after the child's birth; however, if levels remain high postpartum, women are reclassified as having type 2 diabetes. Rates of GDM appear to reflect the rising incidence and prevalence of type 2 diabetes among Aboriginal populations in general. Several studies have investigated risk factors associated with the rising rates of GDM in Canadian Aboriginal populations. The majority of this research has, however, concentrated on screening for and comparing GDM rates based on ethnicity between populations of Aboriginal and non- Aboriginal women. Reported prevalence rates for GDM range from 4.6% among Navajo women to 15.3% in Zuni compared to between 0.15 - 14.5% in the usual U.S. population. Over 0.15% to 12.3% of pregnancies develop gestational diabetes complications (1); these complications can result in the long term adverse health complications for both mother and infant post pregnancy. Gestational diabetes is classified as a mild disease, but its high prevalence in pregnancies makes this disease formidable and important to understand. Increasing the public's knowledge of this disease will help prevent its onset and management upon onset (Melissa 1994). A major source of information for this disease can originate from health care providers pre and post partum. This report aims to coalesce conflicting information pertaining to the disease, while suggesting a method of informing the public via nurse interventions pre and post partum.

Onset

Gestational diabetes mellitus (GDM) is the onset of glucose intolerance during pregnancy. The disease usually develops during late pregnancy because this stage of pregnancy requires increased supply of nutrient to the fetus thus increasing peripheral insulin resistance and hyperinsulinemia (2). Other risk onsets include obesity, increases in maternal age over 35, obesity, due to genetics and family history, or previous pregnancies with this disease onset. Racial background might also play a role in GDM onset; a study relating multiracial relationship to GDM showed that females of ethnic origins have higher relative risk to developing this disease: relative risks for black, southeast Asian and Indian women were 3.1, 7.6, and 11.3 while Caucasian females have lower relative risk (1). This increased risk factor in non caussian females might be genetically or environmentally determined. Epigenetic factors might play a role in the complex interplay between genetics and environment towards insulin resistance and GDM (2). The most commonly reported risk factors for gestational diabetes are increased maternal age, weight and parity, as well as the previous delivery of amacrosomatic infant and being a member of a "high risk"population, such as women of Aboriginal, Hispanic, South Asian, Asian and African descent (Dornhorst 2008). The most commonly identified risk factors for GDM are those of maternal origin and tend to conform to those risk factors traditionally associated with type 2 diabetes (De Veciana ...