Table of Contents:

1. Pathophysiology 4. Diagnostic Studies

2. Risk Factors 5. Interventions & Client
3. Clinical Manifestations Teaching

Gestational Diabetes
1. Pathophysiology 3. Clinical Manifestations
Diabetes mellitus = impaired glucose metabolism. y Hyperglycemia:
y Glucose can’t reach cells  Cells starve + y 3 “Ps”: Polyuria, polyphagia, polydipsia
Glucose builds up in blood y  fundal height from fetal macrosomia and
polyhydramnios (excess amniotic fluid):
FIGURE 1. DIABETES
FIGURE 2. INCREASED FUNDAL HEIGHT

y Diabetes mellitus is classified as type 1 (T1DM),

type 2 (T2DM), or gestational diabetes (GDM) (see
DIABETES CHEAT SHEET).
y GDM:
y Higher levels of placental hormones (estrogen,
progesterone) and cortisol in the 2nd and 3rd
4. Diagnostic Studies
trimester insulin resistance 
circulating glucose (hyperglycemia)
Clients are screened for GDM between
y Usually resolves postpartum 24-28 weeks gestation.
y GDM is diagnosed if:

Maternal & Newborn

2. Risk Factors y Positive screening result for two-step oral
glucose challenge test (GCT) (FIGURE 3)
y Overweight
y History of GDM or signs of GDM in previous
pregnancy (macrosomia)
y Maternal age >25 years
y High-risk ethnic groups (Hispanic, Black)
y First-degree relative with diabetes

 GDM screening: Screen for GDM between 24-28 weeks gestation using a non-fasting 1-hour
oral glucose challenge test (GCT). If 1-hour GCT is positive, a fasting 2-hour CGT is performed.

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4. Diagnostic Studies, Continued y Blood sugar management:
y Blood glucose levels are monitored to
FIGURE 3. SCREENING FOR GESTATIONAL DIABETES evaluate whether blood sugar can be
controlled with diet and exercise alone.
y Teach client to monitor blood glucose as
prescribed (usually four times daily):
y Measure post-prandial glucose 1-2 hr
after eating.

If hyperglycemia persists despite healthy
diet and exercise:
y Insulin may become necessary for T2DM
and GDM.
y doses of insulin will be required during
pregnancy for clients who have T1DM.
y Monitor for signs of hypoglycemia (shaky,
clammy, confused).
y Treat hypoglycemia by following the “Rule
of 15”: 15 grams of carbohydrates +
Recheck glucose in 15 min (see DIABETES
CHEAT SHEET).
2. Monitor maternal and fetal well-being:
5. Interventions & Client Teaching
y Uncontrolled hyperglycemia in pregnancy can
The #1 priority for clients with diabetes during pregnancy
cause several maternal and fetal complications
= maintaining tight glycemic control to ensure maternal
(FIGURE 4).
and fetal well-being and prevent complications like
y Fetal complications:
spontaneous abortion and neural tube defects. y Spontaneous abortions
Interventions for GDM focus on: y Congenital malformations (neural
1. Teaching diabetes management tube defects)
2. Monitoring maternal and fetal well-being y Intrauterine growth restriction (IUGR)
3. Managing birth and newborn complications
Macrosomia (newborn weight ≥4,000 g
1. Teach diabetes management: [8 lbs 13 oz])
y Diet and exercise: y Maternal complications:

GDM is treated with diet and exercise first,
Preeclampsia (BP ≥140/90, vision changes,
then insulin as needed. headaches)

Exercise 30-60 min daily. y Frequent UTIs: Glucosuriabacterial growth
y Eat a balanced diet: y Assess for complications:

Divide daily caloric needs between 3 meals y Monitor blood glucose as prescribed.
and 2-3 snacks (never skip meals). y Perform early and frequent fetal surveillance:

Maternal & Newborn

Eat high-fiber, complex carbohydrates y Ultrasound measurements to assess fetal
(brown rice) and limit simple sugars (white growth and amniotic fluid volumes
bread, candy). y Non-stress tests and biophysical
y Consult with a registered dietician. profiles to assess fetal well-being

 Lifestyle changes: Teach clients with GDM to manage blood glucose with diet and exercise.
Divide daily calorie needs between 3 meals and 2-3 snacks.

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5. Interventions & Client Teaching, Continued
3. Manage birth and newborn
FIGURE 4. COMPLICATIONS OF GDM
complications:
y During labor, strict glycemic
control is necessary torisk of
neonatal hypoglycemia (FIGURE 4).
y Monitor maternal blood
glucose levels every hour.
y Administer IV fluids with
dextrose (D5NS) and insulin
as needed to maintain normal
glucose levels during labor.
y Clients with GDM are at risk
for birth complications of
macrosomia:

Postpartum hemorrhage
(PPH): Uterine overdistention =
risk for uterine atony  PPH y Hypoglycemia = <45 mg/dL (2.5 mmol/L)
y Birth injuries (perineal lacerations, in the first 72 hr of life
shoulder dystocia)
If newborn is hypoglycemic and alert,
y After birth, assess newborn blood glucose and give oral feedings (breastfeed).
monitor for complications due to GDM:
If newborn cannot feed or
y Assess newborn hypoglycemia persists, treat with IV
blood glucose per dextrose instead.
facility policy: y Newborn complications:

Place heel warmer y Hypoglycemia:
on newborn to
Persistent jitters or tremors
improve blood y Hypothermia
flow and prevent
Respiratory distress: Insulin inhibits
false surfactant production in the fetal lungs:
low results. y Monitor newborn for grunting,

Obtain blood tachypnea.
sample from the
lateral heel.

Maternal & Newborn

 Risk for preeclampsia and PPH: Clients with  Newborn hypoglycemia symptoms: If a newborn
GDM are at increased risk for preeclampsia and has signs of hypoglycemia, such as persistent
PPH. Monitor the client for uterine atony and jitters or hypothermia, assess blood glucose by
teach client to report signs of preeclampsia such warming the heel to promote blood flow, then
as BP ≥140/90, headaches, and visual changes. collect a blood sample from the lateral heel.
 Newborn hypoglycemia treatment: If the
newborn is hypoglycemic and alert, give oral
feedings. If hypoglycemia persists, give IV
glucose.

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  Screen for GDM between __-__ weeks gestation  If the newborn has persistent jitters or
using a _____ (fasting or nonfasting?) 1-hour oral hypothermia, assess for _____, but first,
glucose challenge test. prevent falsely low glucose values by warming
the newborn’s _____.
 Teach clients diagnosed with GDM to first
manage blood sugars with _____ and _____.  If a newborn has hypoglycemia and is alert,
Divide daily caloric needs between _____ meals treat with oral feedings. Treat persistent
and _____ to _____ snacks. hypoglycemia with ____.

 Monitor the postpartum client for uterine _____

and teach clients to report signs of preeclampsia,
including BP ≥___/___, headaches, and
______ changes.

Answers: 1. 24-28 weeks, non-fasting 2. diet, exercise, 3, 2 to 3 3. atony, 140/90, vision 4. hypoglycemia, heel 5. IV glucose

Maternal & Newborn

References:

Keenan-Lindsay, L., Sams, C., & O’Connor, C. (2022). Perry’s McKinney, E., Mau, K., Murray, S., James, S., Nelson, K., Ashwill,
maternal child nursing care in Canada (3rd ed.). Elsevier J., & Caroll, J. (2022). Maternal-child nursing (6th ed.).
Health Sciences. Elsevier Health Sciences.

Lowdermilk, D., Cashion, M. C., Alden, K. R., Olshansky, E.F., &

Attributions:
Perry, S. (2023). Maternity and women’s health care (13th
ed.). Elsevier Health Sciences (US). • Heel Stick: Modified from BioRender.com
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