Diabetes and Pregnancy

1
Diabetes and Pregnancy

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

2
Brief Overview Why is it Relevant?

• 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

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Brief Overview Why is it Relevant?

• 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

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How Diabetes Impacts Womens Health/Neonatal
Nursing

• 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.)

5
How Diabetes Impacts Womens Health/Neonatal
Nursing

• 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

6
How Diabetes Impacts Womens Health/Neonatal
Nursing

• 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

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Pathophysiology

• 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

8
Pathophysiology

• 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

9
Type I and Type II Diabetes

• Type I DM - destruction of beta cells leading to
  absolute insulin deficiency
• Type II DM- combination of insulin secretion
  defect, and insulin resistance

10
Gestational Diabetes

• Carbohydrate intolerance with variable severity
  with onset or first recognition during pregnancy
• As gestation progresses blood glucose levels
  increase as insulin sensitivity decreases

11
Gestational Diabetes

• 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.

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Implications on Nursing Practice

• 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

13
Risk factors

• 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

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Signs and Symptoms

• 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

15
Treatment Dietary

• 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.

16
Treatment Medication

• 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.

17
Prevention Education

• 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, gt 25 years of age

18
Prevention Education

• 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

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Prevention Tests and Exams

• 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

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Prevention Diet and Exercise

• 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

21
Prevention Diet and Exercise

• Follow regular exercise routines such as walking
  at least 3 times per week
• Insulin therapy, if necessary
• Monitor weight gain

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References

• Davidson, M. London, M., Ladewig, P. (2008).
  Olds Maternal-Newborn Nursing Womens 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-ove
  rview
• http//www.nlm.nih.gov/medlineplus/ency/article/00
  0896.htm