Emily Spencer, Melissa Warren, Quang Pham and Sherita Green.

Emily Spencer, Melissa Warren, Quang Pham and

Sherita Green

Diabetes rates are increasing for women in the reproductive years (18-44)

From 1990-1998 rates increased 70% for women aged 30-39 years old

About 8.1 million women in American have diabetes

Between about 2-7% of expectant mothers develop gestational diabetes

A strong presence of diabetes in our country places added demands on the healthcare delivery system

Children exposed to diabetes in the womb have a greater likelihood of becoming obese during childhood and adolescence and for developing type II diabetes later in life

It is important to educate women with type I or II diabetes on what they can do to have a healthy baby (get diabetes under control 3-6 months before trying to get pregnant; if pregnant, see healthcare provider; diet; etc.)

Although expectant mother with diabetes can and do have normal healthy pregnancies and deliveries, they are at greater risk for complications such as preeclampsia, cesarean section, and infections

Gestational diabetes usually ends after baby is born, but women with gestational diabetes have up to a 45% risk of recurrence with the next pregnancy and up to a 63% risk of developing type 2 later in life – this leads to future health implications

Insulin produced by beta cells in the pancreas lowers blood glucose levels by enabling glucose to move into muscle and liver cells where it is stored as glycogen.

Falling blood glucose levels stimulate pancreas to release glucagon

Glucagon stimulates breakdown of glycogen stores into glucose which returns to the blood stream

In DM, pancreas does not produce enough insulin to allow proper carbohydrate metabolism

Without proper amounts of insulin glucose cannot enter cells for storage and stays in blood

Type I DM - destruction of beta cells leading to absolute insulin deficiency

Type II DM- combination of insulin secretion defect, and insulin resistance

Carbohydrate intolerance with variable severity with onset or first recognition during pregnancy

As gestation progresses blood glucose levels increase as insulin sensitivity decreases

For maintenance of glucose control during pregnancy maternal insulin secretion must increase enough to counteract the fall in sensitivity

GDM occurs when there is not enough insulin to counteract the pregnancy related decrease in insulin sensitivity.

Emphasize importance of prenatal healthcare

Educate about warning signs like excessive weight gain, eating healthy and exercising throughout pregnancy

Educate about signs and symptoms of hyperglycemia

Make sure woman and possibly family members know how to check blood sugar levels

Age (35 years or older) Previous infant that was LGA (4000 g) Unexplained fetal demise History of gestational diabetes Family history of type II or gestational

diabetes Obesity (90 kg or greater) Fasting glucose of 140 mg/dL or a

random glucose of 200 mg/dL

Polyuria, Polydispsia and Polyphagia Unexplained weight loss Numbness and tingling in hands and

feet Fatigue Sudden vision changes Dry skin Slow healing wounds Increased infections

Eat 3 regular meals with 3 snacks during the day. Avoid large meals.

Carbohydrates should not account for more than 50% with protein and fat equally accounting for the remainder.

If obese, a 33% calorie restriction is advised.

Insulin therapy such as lispro, regular, and NPH can be used safely during pregnancy.

Adjustments to short-acting insulin may be needed as pregnancy progresses due to glucose surges.

Insulin pumps can also be used throughout pregnancy safely and effectively.

Hypoglycemic agents such as Glyburide and Metformin can be used.

Encourage pregnant women to follow prenatal check-ups regularly.

Teach pregnant women about risk factors of gestational diabetes such as African, obesity, family history of diabetes, > 25 years of age

Teach pregnant women about gestational diabetes’ symptoms such as blurred vision, fatigue, frequent infection, increased thirst, increased urination, nausea and vomiting

Teach pregnant women how to use glucose meter and self monitoring of blood glucose levels

Have oral glucose tolerance test at 24th and 28th week

Have a nonstress test during pregnancy for monitoring fetal well being

Have ultrasound exams to monitor fetal gestational age and fetal growth

Manage diet and food consumptions such as calories, nutrient to control blood glucose

Avoid eating high glucose foods and eat variety of healthy foods

Take prenatal vitamin supplements

Follow regular exercise routines such as walking at least 3 times per week

Insulin therapy, if necessary Monitor weight gain

Davidson, M. London, M., & Ladewig, P. (2008). Old’s Maternal-Newborn Nursing & Women’s Health Across the Lifespan (8th ed.) Upper Saddie River: Pearson Prentice Hall. (p. 450-460)

http://www.cdc.gov Diabetes Mellitus. University of California, San Francisco. Retrieved

http://www.ucsfhealth.org/adult/medical_services/hormone/diabetes/conditions/diabetes/signs.html

Diabetes Mellitus and pregnancy. Emedicine. Retrieved http://emedicine.medscape.com/article/127547-overview

http://www.nlm.nih.gov/medlineplus/ency/article/000896.htm