Gestational Diabetes
Occurs in 1 in 300 pregnancies. At prenatal visit will do urine analysis to test for glucose and ketones. At 24-28 weeks, a 1-hour diabetic screening test is done. Given 50g of glucose to drink and 1 hour after a blood sample is taken. If >40mg then a 3-hour glucose tolerance test is done. Will be doing a fasting blood sugar and a 2-hour postprandial (after eating).
Causes:
Stress of pregnancy causes abnormal glucose tolerance.
The placenta produces HPL. It is an insulin antagonist (counteracts its action on glucose).
Increased glucose needs to meet the metabolic needs of mom and baby. Baby takes glucose and if mom does not have glucose she burns fat and produces ketones.
Estrogen and progesterone produced by the placenta will counteract action of insulin on glucose.
Increase in cortisol secreted by the adrenal glands. Cortisol increases gluconeogenesis (synthesis of glucose from non-CHO nutrients). This increases blood sugar. Insulin doesn’t work at the cellular level.
Signs that indicate a tendency to develop gestational diabetes:
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Large babies. 9lb or larger. Macrosomia.Ÿ
Mom may have polyhydramnios.Ÿ
Family history of diabetes.Ÿ
Obesity.Ÿ
Unexplained fetal losses.Ÿ
Classic signs of diabetes. The 3 polys.Adverse effects of diabetes on mom:
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Tendency for polyhydramnios.Ÿ
Tendency for PROM.Ÿ
PIH.Ÿ
Aging placenta.Ÿ
Infection.Ÿ
Difficult labor.Ÿ
After delivery at risk for postpartum hemorrhage.Adverse effects on fetus:
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After delivery, at risk for respiratory distress syndrome during 1st 6-8 hours.Ÿ
Often developmentally immature.Ÿ
At risk for hypoglycemia. A dextrose stick is done and may be 60-90. After delivery, the source of sugar is severed, but insulin is still produces. Baby will have the shakes. Blood sugar <45, will give sugar water and the retest.Ÿ
At risk for hypocalcemia. Born prematurely and do not receive calcium that mom gives at last week of pregnancy. Can also cause jitters. Low = anything <7mg/dL.Ÿ
Hyperbilirubin. Hct will be >65% due to polycythemia (many RBC). The liver is immature and can’t break down the RBC’s.Treatment for the gestational diabetic mom:
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Diet with more liberal caloric intake. Because we don’t want her to burn her fat. 2300 kc and exercise.Ÿ
Accucheck.Ÿ
Does not need extra insulin during first trimester.Ÿ
2nd and 3rd trimesters, insulin needs increase 2-4 times. May have to go on insulin.Ÿ
Insulin requirements drop during labor and delivery.Ÿ
Do not give orals.NST to monitor fetus at 32 weeks. Done weekly.
Scheduled to be delivered about 36th week because baby is large, increased still birth chance, and placenta ages more readily in a diabetic.
If cervix isn’t ready then C-section is done.
Heart Problems
Blood volume increases from 1200 - 1500cc. This puts more strain on the heart. Blood volume will peak between 28-32 week. Any existing heart problems at this time cause a greater risk for CHF.
Genital Herpes
No cure. If mom has it then a C-section is done.
She is at greater risk for cancer.
Hyperemesis Graviderum
Severe n/v that goes beyond 1st trimester. Will get dehydrated and F&E imbalance. Caused by hormones and increased production of HCG. On high CHO and PRO diet. Can get severe enough to hospitalize for IV therapy and antiemetics. Monitor I&O. Record amount and # of times vomited. Record daily weight.
Clear liquid, advance to bland and avoid spicy foods. Some require a psych consult.
Teratogens
Chemical and other non-genetic substances that interfere with fetal development.
Ex: drugs, viruses, infection, STD’s.
We use the T-O-R-C-H method to remember this.
T: toxoplasmosis. Parasite transmitted by raw or improperly cooked meat and found in feces of an infected cat. S&S: rash, enlarged spleen, flue-like symptoms. Dx: thru blood test. Tx: sulfa dyazine and pyrimethamine.
O: others, such as STD, HIV, and hepatitis.
R: rubella. Don’t want to contact during 1st trimester because the fetus can have deafness, cataracts, heart defects and/or be mentally retarded. If titer is 1:16 = immune.
C: cytomegalo virus. Type of herpes and it inhabits our salivary glands. Can transmit by placenta or at birth. Causes mental retardation and congenital deafness.
H: herpes simplex. NO cure. Deliver by C-section.
Anemia
Can have a physiological anemia due to hemodilution. Not a disease by a sign of many diseases. Most common cause is lack of building blocks for RBC’s, such as iron, folic acid and vitamin B12. Most anemic women during pregnancy have iron deficiency anemia.
Extra iron is needed during pregnancy because the mom’s RBC’s increase and iron makes Hbg in these RBC’s. Iron is also needed to make fetal RBC’s. Baby is going to have to store iron for the first 3-6 months of extra-uterine life.
First food is milk and it is a poor source of iron.
In utero, the GI tract is sterile, so there is no intestinal bacterial, which is necessary for production of B12 which, is needed for maturation of RBC. At greater risk for infection, delayed wound healing, and hemorrhage postpartum.
