Exploring the patho, signs/symptoms, diagnostics, patient care strategies and education of expectant mothers experiencing gestational diabetes.

1. Gestational Diabetes
Brook King and Matthew Variot

2. Learning Objectives
1. Understand what gestational diabetes is and the effects it has
on mom and baby
2. Understand signs and symptoms of gestational diabetes
3. Understand how gestational diabetes is diagnosed/treated

3. Pathophysiology behind Gestational Diabetes
Exact patho is unknown, but one main aspect of this disease is
insulin resistance. (where the cells in body don’t respond properly
to insulin)
Resulting in an imbalance in the amount of sugar in the blood.

4. Objective symptoms
-Increase in blood sugar
-Sugar in urine

5. Subjective Symptoms
-Excecssive thirst/dry mouth
-Frequent urination (ontop of pregnancy peeing)
-Recurring infections such as yeast/thrush
-Weakness
-Blurred Vision

6. Diagnostics
Glucose tolerance testing
1 hour: (every pregnant woman) Drink a liquid containing glucose and a blood
sugar level draw 1 hour later.
When level is higher than normal, get the 3 hour test. If normal level, no
further testing.
3 hour: Don’t eat or drink 8-14 hrs before/during test, test blood sugar before drink,
drink the glucose liquid and check glucose every hour for 3 hours.

7. Specific History Data
Prior Hx of diabetes/ gestational diabetes in previous pregnancy
Family Hx of diabetes

8. Review of Systems Questions
What body system is affected by gestational diabetes?
Does the increase is blood sugar only affect mom?

9. Assessments to Be Done
Pt. Hx/family Hx
BMI
Blood glucose levels (glucose tests)
1-3 hour glucose test

10. Care During Labor/Postpartum
Treatment during pregnancy: During labor Postpartum
Monitoring blood glucose levels Birth Plan (if vaginal/ Breastfeed (to help
Administering insulin therapy cesarean needed) babies bs levels)
(if necessary) Assisted birth if needed Monitor/treat any
Change in diet/exercise and (forceps/vacuum) remaining bs
weight management Monitoring for comps imbalances
r/t large baby delivery

11. Patient Education
Avoid sugary, carb heavy foods
Eat smaller portions, snack more through the day
How/when to check blood sugars
Usually dietary control is enough
Risk of later DM development

12. National Guidelines of Care
GDM screening should be before 24weeks, sooner if high risk
Initial mgmt involves diet change, exercise, and glucose monitoring
Target blood glucose is 95mg; less than 140 fasting
Pharm intervention includes metformin, gluburide or insulin when apropriate
Future screening for Glucose levels recommended for mom and baby

13. Implications for Fetus/Newborn
Short term: Post delivery hypoglycemia (from the sudden lack of mom’s sugar and baby
having to adjust to own body’s production)
Long Term: Macrosomic baby (large size)
Delivery trauma, risk for future DM, higher risk for obesity, some studies suggest a
link with autism

14. Case Study
A 34-year-old Hispanic-American woman who is in her second pregnancy and has had
one live birth and no abortions is seen for prenatal care at 24 weeks gestation. Her
weight is 220 lb, and her blood pressure is 130/80 mmHg. Uterine size is appropriate for
gestational age. The patient's past obstetric history includes the spontaneous vaginal
delivery of a 9 lb, 8 oz. male infant at 40 weeks gestation, 8 years ago in Mexico. The
patient reports that the child is doing well. Her family history reveals that her mother
has type 2 diabetes mellitus. A urine dipstick shows 3+ glycosuria and negative ketones.

15. Video
Video - link -> https://www.youtube.com/watch?v=_0oP1MGe9Lw
<iframe width="560" height="315" src="https://www.youtube.com/embed/_0oP1MGe9Lw" frameborder="0"
allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>

16. Case Study Questions
1. What tests should be done to evaluate the patient's glucose tolerance?
2. How is the diagnosis of gestational diabetes mellitus (GDM) established?
3. What would be the best treatment and follow-up strategy?

17. Peer Reviewed Resources
1. Parnell, A., Correa, A., & Reece, E. (2017). Pre-pregnancy Obesity as a
Modifier of Gestational Diabetes and Birth Defects Associations: A
Systematic Review. Maternal & Child Health Journal, 21(5), 1105–1120.
https://doi-org.pnw.idm.oclc.org/10.1007/s10995-016-2209-4
2.Garrison, A. (2015, April 01). Screening, Diagnosis, and Management of Gestational
Diabetes Mellitus. Retrieved from https://www.aafp.org/afp/2015/0401/p460.html
3. Diabetes in Pregnancy. (n.d.). Retrieved November 15, 2018, from
https://www.ucsfhealth.org/education/diabetes_in_pregnancy