Evidence-Based Overview of Gestational Diabetes (Nursing)
Introduction
Gestational diabetes is defined as any degree of glucose intolerance that has its onset or is first diagnosed during pregnancy. Kuhl, Hornnes, and Andersen (1985) state that gestational diabetes occurs when the pancreas of a pregnant woman fails to increase insulin production to compensate for the natural decrease in cells’ sensitivity to insulin. The cardinal signs of diabetes are polyuria (related to decreased reabsorption at the renal tubules because of the osmotic activity of glucose), polydipsia (related to polyuria), polyphagia (related to starved cells as a result of inability to transport glucose into cells), and weight loss (related to the use of fat and muscle tissues for energy). If left untreated, the extra glucose in the blood can pass to the baby through the placenta, causing the baby to boost insulin production. All that excess glucose is stored in the baby as fat leading to a large for gestational age size, which can complicate delivery. Also, the baby’s overproduction of insulin may increase his or her risk of obesity and type two diabetes later in life (Joslin Diabetes Center, 2008).
This phenomenon occurs in about four percent of all pregnancies and is more common in women with one or more of the following risk factors: overweight, over 30 years of age, strong family history of diabetes, previously had a baby weighing more than nine pounds at birth, polycystic ovary syndrome, glycosuria, impaired fasting glucose or impaired glucose tolerance, and African-American, Hispanic, Asian, American Indian, or a Pacific Islander descent (Ladewig, London, and Davidson, 2009).
According to the text, the prognosis of gestational diabetes without significant vascular damage is positive (Ladewig et al. 2009). However, there are still more risks associated with the diagnosis compared to a normal pregnancy. One of the maternal risks of gestational diabetes is hydramnios, or increased amniotic fluid, can occur in 10-20% of diabetic
Gestational diabetes is defined as any degree of glucose intolerance that has its onset or is first diagnosed during pregnancy. Kuhl, Hornnes, and Andersen (1985) state that gestational diabetes occurs when the pancreas of a pregnant woman fails to increase insulin production to compensate for the natural decrease in cells’ sensitivity to insulin. The cardinal signs of diabetes are polyuria (related to decreased reabsorption at the renal tubules because of the osmotic activity of glucose), polydipsia (related to polyuria), polyphagia (related to starved cells as a result of inability to transport glucose into cells), and weight loss (related to the use of fat and muscle tissues for energy). If left untreated, the extra glucose in the blood can pass to the baby through the placenta, causing the baby to boost insulin production. All that excess glucose is stored in the baby as fat leading to a large for gestational age size, which can complicate delivery. Also, the baby’s overproduction of insulin may increase his or her risk of obesity and type two diabetes later in life (Joslin Diabetes Center, 2008).
This phenomenon occurs in about four percent of all pregnancies and is more common in women with one or more of the following risk factors: overweight, over 30 years of age, strong family history of diabetes, previously had a baby weighing more than nine pounds at birth, polycystic ovary syndrome, glycosuria, impaired fasting glucose or impaired glucose tolerance, and African-American, Hispanic, Asian, American Indian, or a Pacific Islander descent (Ladewig, London, and Davidson, 2009).
According to the text, the prognosis of gestational diabetes without significant vascular damage is positive (Ladewig et al. 2009). However, there are still more risks associated with the diagnosis compared to a normal pregnancy. One of the maternal risks of gestational diabetes is hydramnios, or increased amniotic fluid, can occur in 10-20% of diabetic
Cited: Kuhl, C., Hornnes, P.J., Andersen, O. (1985). Etiology and Pathophysiology of Diabetes Mellitus. Diabetes, 3 (Supp Ladewig, P. W., London, M. L., & Davidson, M. R. (2009). Contemporary maternal-newborn nursing care (7th ed.) US News and World Report: Health, Joslin Diabetes Center (2008). Gestational Diabetes. [ONLINE] Available at: http://health.usnews.com/health-conditions/diabetes/gestational- diabetes. [Last Accessed April 19, 2013]. Hillier, T.A., Vesco, K.K., Pedula, K.L., Beil, T.L., Whitlock, E.P., Pettitt, D.J. (2008). Screening for Gestational Diabetes Mellitus: A Systematic Review for the U.S The American College of Obstetricians and Gynecologists (2011). Screening and Diagnosis of Gestational Diabetes Mellitus 0Mellitus.aspx. [Last Accessed April 19, 2013]. Goh, J.E.L., Sadler, L., Rowan, J. (2011). Metformin for gestational diabetes in routine clinical practice. Diabetic Medicine, 28(9), pp.1082-1087