What are fetal complications from maternal diabetes that the nurse must monitor for?
Poor glycemic control during the later stages of pregnancy increases the rate of fetal macrosomia, defined as a birth weight of more than 4000 g. The macrosomic fetus of the diabetic mother tends to have a disproportionate increase in shoulder, trunk, and chest size, leading to risk of shoulder dystocia. Failure of fetal descent or labor progress leads to difficult vaginal birth. A vaginal birth may lead to birth injuries in the infant, such as facial nerve injury. Ketoacidosis is a result of uncontrolled glycemia, which affects the mother during pregnancy. Hypoglycemia, not hyperglycemia, is a risk for infants born to diabetic mothers. In the later stages of pregnancy, hypoglycemia may occur as insulin doses are adjusted to maintain a normal blood glucose level. (B,C,D) Show
What is gestational diabetes mellitus?Gestational diabetes mellitus (GDM) is a condition in which a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells. Unlike type 1 diabetes, gestational diabetes is not caused by a lack of insulin, but by other hormones produced during pregnancy that can make insulin less effective, a condition referred to as insulin resistance. Gestational diabetic symptoms disappear following delivery. Approximately 3 to 8 percent of all pregnant women in the United States are diagnosed with gestational diabetes. What causes gestational diabetes mellitus?Although the cause of GDM is not known, there are some theories as to why the condition occurs. The placenta supplies a growing fetus with nutrients and water, and also produces a variety of hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can have a blocking effect on insulin. This is called contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy. As the placenta grows, more of these hormones are produced, and the risk of insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results. What are the risks factors associated with gestational diabetes mellitus?Although any woman can develop GDM during pregnancy, some of the factors that may increase the risk include the following:
Although increased glucose in the urine is often included in the list of risk factors, it is not believed to be a reliable indicator for GDM. How is gestational diabetes mellitus diagnosed?The American Diabetes Association recommends screening for undiagnosed type 2 diabetes at the first prenatal visit in women with diabetes risk factors. In pregnant women not known to have diabetes, GDM testing should be performed at 24 to 28 weeks of gestation. In addition, women with diagnosed GDM should be screened for persistent diabetes 6 to 12 weeks postpartum. It is also recommended that women with a history of GDM undergo lifelong screening for the development of diabetes or prediabetes at least every three years. What is the treatment for gestational diabetes mellitus?Specific treatment for gestational diabetes will be determined by your doctor based on:
Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:
Possible complications for the babyUnlike type 1 diabetes, gestational diabetes generally occurs too late to cause birth defects. Birth defects usually originate sometime during the first trimester (before the 13th week) of pregnancy. The insulin resistance from the contra-insulin hormones produced by the placenta does not usually occur until approximately the 24th week. Women with gestational diabetes mellitus generally have normal blood sugar levels during the critical first trimester. The complications of GDM are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of diabetes is made. Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum magnesium levels, but, in general, there are two major problems of gestational diabetes: macrosomia and hypoglycemia:
Blood glucose is monitored very closely during labor. Insulin may be given to keep the mother's blood sugar in a normal range to prevent the baby's blood sugar from dropping excessively after delivery. What are the fetal complications of gestational diabetes?If you have gestational diabetes, your baby may be at increased risk of:. Excessive birth weight. ... . Early (preterm) birth. ... . Serious breathing difficulties. ... . Low blood sugar (hypoglycemia). ... . Obesity and type 2 diabetes later in life. ... . Stillbirth.. What are potential complications for infants born to diabetic mothers?Possible Complications. Congenital heart defects.. High bilirubin level (hyperbilirubinemia).. Immature lungs.. Neonatal polycythemia (more red blood cells than normal). ... . Small left colon syndrome. ... . Difficulty with delivery due to large size of the baby (if blood sugar is not well controlled).. |