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Risk For Fetal Injury Related To Gestational Diabetes

Gestational Diabetes And The Neonate: Challenges And Solutions

Gestational Diabetes And The Neonate: Challenges And Solutions

Authors Stewart A, Malhotra A Accepted for publication 6 January 2015 Checked for plagiarism Yes Peer reviewer comments 4 1Monash Newborn, Monash Health, 2Department of Paediatrics, Monash University, Melbourne, VIC, Australia Abstract: The prevalence of gestational diabetes mellitus (GDM) is rising worldwide, along with overweight and obesity. In utero exposure to hyperglycemia increases perinatal complications including preterm birth, macrosomia, neonatal respiratory distress, hypoglycemia, and polycythemia. More significantly, GDM places the offspring at risk of insulin resistance and type 2 diabetes mellitus, obesity and cardiovascular disease. The relative contributory roles of the intrauterine environment, shared genes, and postnatal environment on long-term outcomes are not yet fully understood. Maternal obesity in particular remains a significant confounding factor. Opportunities for ameliorating both the perinatal effects and long-term and intergenerational effects of GDM exist at the level of prevention of GDM, screening for and treatment of GDM, and postnatal interventions in offspring. Keywords: gestational diabetes mellitus, GDM, perinatal complications, long-term complications, hyperinsulinism, macrosomia The rising prevalence of gestational diabetes mellitus (GDM), along with perinatal complications secondary to GDM, and a growing understanding of the significant long-term impacts on offspring of women with GDM, is of increasing importance to obstetric and neonatal clinicians at both an individual and population health level. This review article aims to summarize current literature regarding the diagnostic criteria for GDM, both the perinatal and long-term complications of GDM, and interventions to prevent these complications. GDM: definition, prevalence, Continue reading >>

Screening, Diagnosis, And Management Of Gestational Diabetes Mellitus

Screening, Diagnosis, And Management Of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) affects approximately 6% of pregnancies in the United States, and it is increasing in prevalence. Pregnant women without known diabetes mellitus should be screened for GDM after 24 weeks of gestation. Treatment of GDM results in a statistically significant decrease in the incidence of preeclampsia, shoulder dystocia, and macrosomia. Initial management includes glucose monitoring and lifestyle modifications. If glucose levels remain above target values, pharmacologic therapy with metformin, glyburide, or insulin should begin. Antenatal testing is customary for women requiring medications. Induction of labor should not occur before 39 weeks in women with GDM, unless glycemic control is poor or another indication for delivery is present. Unless otherwise indicated, scheduled cesarean delivery should be considered only in women with an estimated fetal weight greater than 4,500 g. Women with a history of GDM are at high risk of subsequently developing diabetes. These patients should be screened six to 12 weeks postpartum for persistently abnormal glucose metabolism, and should undergo screening for diabetes every three years thereafter. Gestational diabetes mellitus (GDM) is a condition of glucose intolerance with onset or first recognition in pregnancy that is not clearly overt diabetes.1,2 Normal pregnancy is characterized by pancreatic β-cell hyperplasia resulting in higher fasting and postprandial insulin levels. Increased secretion of placental hormones leads to increasing insulin resistance, especially throughout the third trimester. GDM occurs when β-cell function is insufficient to overcome this insulin resistance.3 Clinical recommendation Evidence rating References Comments Screening for GDM should occur after 24 weeks of gestat Continue reading >>

Diabetes Mellitus In Pregnancy

Diabetes Mellitus In Pregnancy

(Gestational Diabetes; Pregestational Diabetes) By Lara A. Friel, MD, PhD, Associate Professor, Maternal-Fetal Medicine Division, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Medical School at Houston, McGovern Medical School Pregnancy aggravates preexisting type 1 ( insulin-dependent) and type 2 (non insulin-dependent) diabetes but does not appear to exacerbate diabetic retinopathy, nephropathy, or neuropathy ( 1 ). Gestational diabetes (diabetes that begins during pregnancy [ 2 ]) can develop in overweight, hyperinsulinemic, insulin-resistant women or in thin, relatively insulin-deficient women. Gestational diabetes occurs in at least 5% of all pregnancies, but the rate may be much higher in certain groups (eg, Mexican Americans, American Indians, Asians, Indians, Pacific Islanders). Women with gestational diabetes are at increased risk of type 2 diabetes in the future. Diabetes during pregnancy increases fetal and maternal morbidity and mortality. Neonates are at risk of respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, and hyperviscosity. Poor control of preexisting (pregestational) or gestational diabetes during organogenesis (up to about 10 wk gestation) increases risk of the following: Poor control of diabetes later in pregnancy increases risk of the following: Fetal macrosomia (usually defined as fetal weight > 4000 g or > 4500 g at birth) However, gestational diabetes can result in fetal macrosomia even if blood glucose is kept nearly normal. Guidelines for managing diabetes mellitus during pregnancy are available from the American College of Obstetricians and Gynecologists (ACOG [ 1 , 2 ]). 1. Committee on Practice BulletinsObstetrics : ACOG Practice Bulletin No. 60: Clinical man Continue reading >>

6 Nursing Diagnosis Related To Gestational Diabetes Nursing Care Plan - Nursing Diagnosis And Interventions Nurses Books

6 Nursing Diagnosis Related To Gestational Diabetes Nursing Care Plan - Nursing Diagnosis And Interventions Nurses Books

Browse Home Nursing Diagnosis and Interventions 6 Nursing Diagnosis related to Gestational Diabetes 6 Nursing Diagnosis related to Gestational Diabetes Gestational diabetes is a type of diabetes that afflicts women during pregnancy. Being diagnosed with diabetes during pregnancy presents risks for both mothers and their babies. In the case of gestational diabetes an individual's sugar level usually goes back to normal after delivery, nonetheless you will have a significantly greater potential risk of acquiring diabetes type 2 sometime in the future. Having gestational diabetes does not mean the baby will be born with diabetes; however, if gestational diabetes goes untreated or unmonitored, there is high risk for health complications for both mother and infant. This can result in the baby producing too much insulin in the womb and gaining too much weight, thereby, resulting in premature birth. Published in the journal Pediatric and Perinatal Epidemiolgoy in August 2013, included 128,295 pregnancies that took place between 2002 and 2008: Gestational diabetes was diagnosed in 5,606 pregnancies women with depression were 42 percent more likely to develop Gestational diabetes than women without depression. Normally diabetes is detected at the time of routine medical tests which are done during a pregnancy. Under rare circumstances, for example in case your blood sugar level has gone through the roof, chances are you may suffer with a few of the common symptoms of diabetes, for instance: Gestational diabetes is detected via a glucose tolerance test. If your doctor thinks you are at risk, you may be tested as early as 13 weeks into your pregnancy. Otherwise, it is usually taken around week 24 to week 28. The test is administered by drinking a glucose solution, and having bloo Continue reading >>

Failure To Diagnose: Gestational Diabetes | Birth Injury Guide

Failure To Diagnose: Gestational Diabetes | Birth Injury Guide

Gestational diabetes is unfortunately a common occurrence in pregnancy, affecting thousandsof pregnant women in the United States each year. If left undiagnosed and untreated, it can lead to a myriad of medical issues for bother mother and baby. Gestational Diabetes Statistics and Facts According to the American Diabetes Association,gestational diabetes has increased significantly over the past 20 years. The increase has happened for several reasons, including: In many cases, there are no symptoms at all. Some women may go back to a normal blood sugar within a few weeks after delivery. However, other pregnant women may experience: How Does Gestational Diabetes Affect Infants? If gestational diabetes is untreated or even treated poorly, infants are at risk for several health issues. When gestational diabetes develops, the pancreas must work overtime in order to produce the insulin needed for your body. When this occurs, it not only gives an infanthigh blood glucose levels, but the infants pancreas also creates extra insulin in an attempt to rid the additional blood glucose passed down from the mother. Extra insulin and high blood glucose levels can cause infants to develop fetal macrosomia , also known as fat baby syndrome, a condition marked by excessive fetal weight and size. An unusually large infant is at risk for a plethora of birth injuries, including brachial plexus injuries, shoulder dystocia, and more. Additionally, infants are at risk for excessive weight gain later in life. Additionally, if you have high blood sugar during pregnancy, the risk of early labor and delivery significantly increases. Early labor and delivery comes with its own set of risks, including infant respiratory distress syndrome, a health disorder marked by difficulties in breathing. Its im Continue reading >>

Gestational Diabetes In Primary Care

Gestational Diabetes In Primary Care

Home > Gestational diabetes in primary care By Dr Bernadette L. Carpenter, CMT1 endocrinology and Professor Neil Munro, Visiting professor of primary care diabetes - Gestational diabetes is common, affecting one-in-20 pregnancies and is associated with increased obesity - High-risk mothers should be tested for gestational diabetes at 24-28 weeks gestation with a two-hour oral glucose tolerance test (OGTT) - Management of gestational diabetes during pregnancy has been updated - new National Institute for Health and Care Excellence (NICE) guidance was issued in 2015. The prevalence of gestational diabetes is increasing due to the obesity epidemic and increasing maternal age, and is causing a significant burden on both primary and secondary care with up to 5% of pregnancies affected (1,2). Gestational diabetes is a significant complication in pregnancy, which can lead to delivery problems due to large babies (macrosomia), neonatal hypoglycaemia and maternal pre-eclampsia. It is important for primary care providers, including practice nurses, to be up-to-date with current diagnostic criteria, treatment and management of these women to reduce adverse outcomes. In addition, women who have gestational diabetes will have a 7% lifetime risk of developing type 2 diabetes in the future, as pregnancy unmasks susceptibilities to insulin resistance (3). Early identification and careful follow-ups of women with gestational diabetes can help to modify preventable risks factors and reduce their risk of type 2 diabetes and its long-term complications. The diagnosis criteria for gestational diabetes is different from ordinary diabetes and those mothers with positive glycosuria urine dip-stick tests and in high-risk groups should be formally tested. Gestational diabetes is defined as gluc Continue reading >>

4 Gestational Diabetes Mellitus Nursing Care Plans

4 Gestational Diabetes Mellitus Nursing Care Plans

Assess and record dietary pattern and caloric intake using a 24-hour recall. To help in evaluating clients understanding and/orcompliance to astrict dietary regimen. Assess understanding of the effect of stress on diabetes . Teach patient about stress management and relaxation measures. It is proven that stress can increase serum blood glucose levels, creating variations in insulin requirements. Weigh the client every prenatal visit . Encourage the client to periodically monitor weight at home between visits. Weight gain serves as anindicator for determining caloric adjustments. Observe for thepresence of nausea and vomiting, especially during the first trimester. Nausea and vomiting may be brought about by adeficiency in carbohydrates, which may result inthemetabolism of fats and development of ketosis. Teach the importance of regularity of meals and snacks (e.g., three mealsor 4 snacks) when taking insulin . Eating very frequent small meals improves insulin function. Teach and demonstrate client to monitor sugar using a finger-stick method. Insulin needs for the day can be adjusted based on periodic serum glucose readings. Note: Values obtained by reflectance meters may be 10-15% lower/higher than plasma levels. Provide information regarding any required changes in diabetic management; e.g., use of human insulin only, changing from oral diabetic drugs to insulin, self-monitoring of serum blood glucose levels at least twice a day (e.g., before breakfast and before dinner) and reducing/changing time for ingesting carbohydrates. Metabolism and maternal/fetal needs fluctuatesduring the gestation period, requiring close monitoring and adaptation. Research suggest antibodies against insulin may cross the placenta , causing inappropriate fetal weight gain. The use of human Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes is one of the most common health issues that can occur during pregnancy. It occurs when the mother is first diagnosed with diabetes partway through the pregnancy. The key to minimizing the effects of gestational diabetes is diagnosing it early through the use of an oral glucose tolerance test. If gestational diabetes is not diagnosed properly, it can lead to macrosomia in the baby (abnormally large fetal size), which puts the baby at risk for neonatal hypoglycemia, trauma, and other complications. It can also lead to jaundice, premature birth, birth asphyxia, and reduced uteroplacental perfusion (RUPP), which harms both mother and child by reducing blood flow between baby and mother. Gestational Diabetes and Birth Injury During pregnancy, hormonal changes can make an expectant mother’s cells less responsive to insulin. When a person’s body needs more insulin, the pancreas secretes more. However, pregnant women often experience increased insulin demand during pregnancy, and, as a result, their pancreases cannot keep up with the demand. Ultimately, these pregnant women experience heightened blood glucose levels with resultant gestational diabetes. Currently, the American College of Obstetricians and Gynecologists (ACOG) and the American Diabetes Association recommend screening all pregnant women for gestational diabetes. Additionally, ACOG states that women who develop pregnancy-related diabetes should be re-tested 6 to 12 weeks after delivering their babies. However, according to a new study of one million patient records, only about two-thirds of pregnant women undergo screening tests for gestational diabetes. Among the 5% of women who tested positive for gestational diabetes, just 1 in 5 were screened again within 6 months of giving birth, expl Continue reading >>

Fetal Complications Of Gdm

Fetal Complications Of Gdm

Untreated, moderate or severe gestational diabetes mellitus (GDM) increases the risk of fetal and neonatal complications, and the risk of congenital malformations is slightly increased in infants of mothers with GDM compared to the general population. Maternal obesity increases the risk of gestational diabetes and is an independent risk factor for perinatal complications. There is a positive correlation between maternal blood glucose levels and increased birth weight, and the risk of macrosomia can be reduced by treating glucose levels during pregnancy. Introduction Gestational diabetes is associated with an increased risk of macrosomia, perinatal complications, and a small increase in the risk of congenital malformations. Maternal obesity is often associated with GDM and is in itself an independent risk factor for perinatal complications, and macrosomia is the main factor linked to perinatal complications in GDM. Untreated moderate or severe GDM increases the risk of fetal and neonatal complications. Congenital malformations The risk of congenital malformations is slightly increased in infants of mothers with GDM compared to the general population. GDM comprises two type of diabetes: (1) diabetes strictly related to pregnancy with no increased risk of congenital malformations, and (2) diabetes diagnosed during pregnancy but preexisting before pregnancy with similar risk of congenital malformations to that of preexisting diabetes (3-7%). Thus, increased risk is of congenital malformations is associated with the presence of undiagnosed type 2 diabetes among women with GDM [1]. A relationship exists between the risk of congenital malformations, maternal blood glucose levels, gestational age at diagnosis of diabetes and maternal obesity, all of which are found in type 2 di Continue reading >>

Pregnancy At Risk: / Preexisting Conditions

Pregnancy At Risk: / Preexisting Conditions

Prepared by assistant professor N.Petrenko, MD, PhD Differentiate the types of diabetes mellitus and theirrespective risk factors in pregnancy. Compare insulin requirements during pregnancy, postpartum,and lactation. Identify maternal and fetal risks or complications associatedwith diabetes in pregnancy. Develop a plan of care for the pregnant woman withpregestational or gestational diabetes. Explain the effects of thyroid disorders on pregnancy. Euglycemia Pertaining to a normal blood glucose level; also callednormoglycemia Glucose intolerance firstrecognized during pregnancy Glycosylated hemoglobin A1c Glycohemoglobin, a minor hemoglobinwith glucose attached; the glycosylated hemoglobin concentration represents theaverage blood glucose level over the previous several weeks and is ameasurement of glycemic control in diabetic therapy Hyperthyroidism Excessive functional activity of the thyroid gland hypoglycemiaLess than normal amount of glucose in the blood; usually caused byadministration of too much insulin, excessive secretion of insulin by the isletcells of the pancreas, or dietary deficiency hypothyroidism Deficiency of thyroid gland activity withunderproduction of thyroxine ketoacidosis The accumulation of ketone bodies in the blood as aconsequence of hyperglycemia; leads to metabolic acidosis macrosomia Large body size as seen in neonates of mothers withpregestational or gestational diabetes pregestational diabetes mellitus Diabetes mellitus type 1 or type 2that exists before pregnancy For most women, pregnancy represents a normal part of life. This chapterdiscusses the care of women for whom pregnancy represents a significant risk becauseit is superimposed on a preexisting condition. However, with the active participation of well-motivated women in thetreatmen Continue reading >>

Nursing Care Plan Gestational Diabetes Mellitus | Risk For Fetal Injury ~ Nursing Care Plan And Diagnosis

Nursing Care Plan Gestational Diabetes Mellitus | Risk For Fetal Injury ~ Nursing Care Plan And Diagnosis

Nursing Care Plan for Gestational Diabetes Mellitus Nursing Diagnosis: Risk for fetal injury related to elevated maternal serum glucose levels, changes in circulation. Desired Outcomes: Display normally reactive NST and negative OCT and/or CST. Be full-term, with size appropriate for gestational age. 1. Determine Whites classification for diabetes; explain classification and significance to client/couple. Rationale: Fetus is at less risk if Whites classification is A, B, or C. The client with classification D, E, or F who develops kidney or acidotic problems or PIH is at high risk. As a means of determining prognosis for perinatal outcome, Whites classification has been used in conjunction with (1) evaluation of diabetic control or lack of control and (2) presence or absence of Pedersons prognostically bad signs of pregnancy (PBSP), which include acidosis, mild/severe toxemia, and pyelonephritis. The National Diabetes Data Group Classification, which includes diabetes mellitus (type I, insulin-dependent; type II, noninsulin-dependent), impaired glucose tolerance, and gestational diabetes mellitus, has not yet had prognostic significance in predicting perinatal outcomes. 2. Note clients diabetic control before conception. Rationale: Strict control (normal HbA1c levels) before conception helps reduce the risk of fetal mortality and congenital anomalies. 3. Assess fetal movement and FHR each visit as indicated. Encourage client to periodically count/record fetal movements beginning about 18 weeks gestation, then daily from 34 weeks gestation on. Rationale: Fetal movement and FHR may be negatively affected when placental insufficiency and maternal ketosis occur. Rationale: Useful in identifying abnormal growth pattern (macrosomia or IUGR, small or large for gestational age Continue reading >>

Complications Of Gestational Diabetes

Complications Of Gestational Diabetes

Is my baby at risk of complications now I have gestational diabetes? Gestational diabetes is a serious condition which can cause many complications. The advice given by your diabetes health care professionals should be taken seriously as uncontrolled or poorly controlled gestational diabetes can lead to severe complications. Having gestational diabetes itself automatically causes higher risk of certain complications during pregnancy, although the risk of complications is greatly reduced if gestational diabetes is diagnosed and managed properly throughout your pregnancy. Gestational diabetes only causes bigger babies - expelling the myth! The most well known complication and general cause of concern of gestational diabetes is 'large babies' - the excessive growth caused by excess sugars in the mother's bloodstream. HOWEVER, if gestational diabetes is controlled and managed well, babies are rarely born 'big', but they may suffer other complications which are related to the condition. We often hear new members of our support group say that they are not worried as baby isn't measuring big, but monitoring for other complications which gestational diabetes can cause or be related to is extremely important. Unfortunately there are many more complications which can be related to gestational diabetes and poor glucose control than 'just a big baby'. If you have family and friends that are struggling to understand gestational diabetes, then you may want to refer them to this page and our page on gestational diabetes and the family to have a look. Possible complications if blood glucose levels are not controlled or poorly controlled If gestational diabetes is not managed properly, or goes undetected/undiagnosed, it could cause a range of serious complications for both you and your Continue reading >>

What Is Gestational Diabetes In Pregnancy?

What Is Gestational Diabetes In Pregnancy?

You are here: Home / What Can Go Wrong With The Birth Process? / Doctor and Hospital Negligence During Pregnancy / Gestational Diabetes Lawsuits Gestational diabetes, unlike pregestational diabetes, is acquired during pregnancy. It can affect women who never had diabetes outside of pregnancy. It usually starts midway through the pregnancy, and means that a woman has high blood sugar (called glucose). The body cannot make and use as much insulin as it needs. Insulin is used for help convert glucose into energy. Estimates vary about how common it is, with studies calculating between 1% and 18% of pregnancies. Women are more likely to develop gestational diabetes if they: Had gestational diabetes in a prior pregnancy Previously delivered a baby over 9 pounds Medical Malpractice and Failure to Diagnose Gestational Diabetes Obstetricians must know if their patients have gestational diabetes in order to protect the unborn baby. Unless the woman has risk factors, doctors should screen for gestational diabetes with a glucose loading test (GLT) around 24 to 29 weeks. Women with one or more risk factors should be screened earlyat their first prenatal visit and early in the third trimester if that first screening was negative. In most cases, women with gestational diabetes are started on a diabetic diet, usually limited to 2,200 calories per day and reduced carbohydrate intake (200 to 220 grams). For more on the diets recommended by the American Diabetic Association, click here . Women with gestational diabetes should also exercise regularly, and monitor their blood glucose levels at least four times per day, according to most physicians. For the babys health, electronic fetal monitoring should begin around 32 weeks and continue until delivery. Doctors will use nonstress tests (N Continue reading >>

Consequences Of Gestational And Pregestational Diabetes On Placental Function And Birth Weight

Consequences Of Gestational And Pregestational Diabetes On Placental Function And Birth Weight

Go to: INTRODUCTION Diabetes in pregnant women is associated with an increased risk of maternal and neonatal morbidity and remains a significant medical challenge. Diabetes during pregnancy may be divided into clinical diabetes (women with previously diagnosed with type 1 or type 2 diabetes) and gestational diabetes. The American Diabetes Association defines gestational diabetes as “any degree of glucose intolerance with onset or first recognition during pregnancy”, but provides diagnostic thresholds for fasting and post-glucose loading values. The International Association of Diabetes in Pregnancy Study Groups recently published a consensus derived from the Hyperglycemia Adverse Pregnancy Outcome study data, suggested that all pregnant women without known diabetes should have a 75 g oral glucose tolerance test at 24-28 wk of gestation[1]. Gestational diabetes would be diagnosed if one or more values met or exceeded the following levels of glucose: fasting 5.1 mmol/L, 1 h post glucose 10.0 mmol/L and 2 h post glucose 8.5 mmol/L. While diabetes in pregnancy is associated with increased obstetric risk compared with normal pregnancy, the overall contribution of diabetes to most obstetric and neonatal complications on a population basis is low, with the largest impact being on shoulder dystocia. Except malformations, which are likely to have resulted from preconceptional or periconceptional hyperglycemia, improvements in obstetric practice have led to major reductions in adverse outcomes. Prepregnancy care for women with diabetes was introduced a long time ago and is associated with improved pregnancy outcomes. However, overall pregnancy outcomes remain very poor for women with diabetes with only a third receiving prepregnancy care. The importance of other metabolic fac Continue reading >>

Gestational Diabetes: Risks, Management, And Treatment Options

Gestational Diabetes: Risks, Management, And Treatment Options

Gestational diabetes: risks, management, and treatment options Departments of Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA Correspondence: Catherine Kim, 300 North Ingalls Building, Room 7C13, Ann Arbor, MI 48109-5429, USA, Tel +1 734 936 5216, Fax +1 734 936 8944, Email [email protected] Author information Copyright and License information Disclaimer Copyright 2010 Kim, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. This article has been cited by other articles in PMC. Gestational diabetes mellitus (GDM) is commonly defined as glucose intolerance first recognized during pregnancy. Diagnostic criteria for GDM have changed over the decades, and several definitions are currently used; recent recommendations may increase the prevalence of GDM to as high as one of five pregnancies. Perinatal complications associated with GDM include hypertensive disorders, preterm delivery, shoulder dystocia, stillbirths, clinical neonatal hypoglycemia, hyperbilirubinemia, and cesarean deliveries. Postpartum complications include obesity and impaired glucose tolerance in the offspring and diabetes and cardiovascular disease in the mothers. Management strategies increasingly emphasize optimal management of fetal growth and weight. Monitoring of glucose, fetal stress, and fetal weight through ultrasound combined with maternal weight management, medical nutritional therapy, physical activity, and pharmacotherapy can decrease comorbidities associated with GDM. Consensus is lacking on ideal glucose targets, degree of caloric restriction and content, algorithms for pharmacotherapy, and in particular, the use of oral medications and insul Continue reading >>

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