Disease Affecting Pregnancy

DIABETES MELLITUS
- A chronic, metabolic disorder characterized by a deficiency in insulin production by the
Islets of Langerhans resulting in improper metabolic interaction of carbohydrates, fats,
proteins and insulin.
Incidence
- Maybe a concurrent disease in pregnancy or may have its first onset in pregnancy.
Risk Factors:
1. Family History
2. Rapid Hormonal Change in pregnancy
3. Tumor/infection of the pancreas
4. Obesity
5. Stress
Pathophysiology
Classification of Diabetes Mellitus
Type I Insulin Dependent
DM
Type II Non-Insulin
Dependent DM
Gestational DM

A state characterized by the destruction of the beta cells in the

pancreas that usually leads to absolute insulin deficiency.
A state that usually arises because of insulin resistance
combined with a relative deficiency in production of insulin.
A condition of abnormal glucose metabolism that arises during
pregnancy.
Possible signal of an increased risk for type 2 diabetes later in
life.

Gestational DM
- Carbohydrate intolerance of variable severity with onset or first recognition during
pregnancy.
Etiology
- Increased pancreatic stimulation associated with pregnancy and induced insulin
resistance impaired pancreatic beta cell function
Pathophysiology
- Hormones secreted by the placenta (hPL, progesterone, cortisol and prolactin) antagonize
insulin elevated blood glucose levels
Clinical Manifestations
- Glycusoria on 2 succesive consults
- Recurrent fungal vaginitis
- Ultrasound evidence of macrosomic fetus

Polyhydramnios

Diagnosing DM
1. Screening Test
a. Performed at 26 to 28 weeks gestation
b. Uses 50-g oral glucose challenge
c. Finding: A plasma glucose of 140mg/dL needs a follow up test with 3 hour
glucose tolerance test
2. Glucose Tolerance Test
a. Commonly done between 28 and 34 weeks of pregnancy. The presence of two out
of these four venous samples is considered abnormal result
i. FBS: >10mg/dL
ii. 1 hour after: serum glucose >190mg/dL
iii. 2 hours after: serum glucose >165mg/dL
iv. 3 hours after: serum glucose >145mg/dL
b. 2 hour Postprandial Blood Sugar (PPBS)
i. Abnormal result: >120mg/dL
c. Glycosylated Hemoglobin
i. Normal Value: 4% to 8%
Effects of DM on the Mother and the Baby
Mother
1. Infertility
2. Spontaneous Abortion
3. PIH
4. Infections: moniliasis, UTI
5. Uteroplacental Insuficiency
6. Premature labor
7. Dystocia
8. Caesarean section often indicated
9. Uterine atony

1.
2.
3.
4.

5.
6.
7.
8.

Baby
Congenital anomalies
Polyhydramnios
Macrosomia (LGA)
Fetal hypoxia intrauterine fetal death
(IUFD), still births; increased perinatal
mortality
Neonatal hypoglycemia (common as soon
as 1 hr after birth)
Prematurity
RDS (at 6th hr after birth)
Hypocalcemia

Nursing Implementation
1. Participate in early detection
a. History
b. Symptomatology
c. Perinatal screening
2. Encourage early prenatal management and supervision
a. Frequent, regular prenatal visit
b. Record dietary intake, monitor blood glucose levels several times daily
c. Insulin
d. Serial ultrasonography
e. Hospitalization
3. Provide teaching

a. Signs and symptoms

b. Nature of DM, effects
c. Need for exercise
d. Insulin regulation/self-administration
e. Prompt reporting of danger signs and signs of infection
4. Promote control of DM
Maintaining maternal blood glucose levels within the normal range during
the prenatal and intranatal periods is important to prevent stimulation of
the fetal pancreas hypoglycemia
a. Promote adherence to dietary regimen
b. Exercise
c. Insulin
d. Early labor induction or ceasarean section in the presence of fetal distress
e. Encourage breastfeeding has antidiabetogenic effect
f. Assess clients understanding of her condition and its effects on daily life.
g. Explain the maternal and fetal effects of GDM
h. Discuss and demonstrate self-monitoring of blood glucose level before meals and
at bedtime.
i. Stress the importance of recording blood glucose levels, insulin dose, dietary
intake, periods of exercise, periods of hypoglycemia, kind and amount of
treatment and urine tests results.
j. Explain importance of continued evaluation even during the post partum period
(monitor glucose every 4-6 hours for 24 hours, administer insulin subcutaneously
when needed) and even when blood glucose levels are normal.
k. Arrange for clients consultation with dietician.
l. Encourage regular exercise (3-4x/week, duration of 15-30 minutes, heart rate
maintained between 130-160bpm)
m. Identify and refer client and her family to possible support groups and resources.