Gestational Diabetes Mellitus (GDM)_

What is GDM?
High blood glucose (hyperglycemia) during pregnancy that is usually diagnosed during 2 nd half of
pregnancy. The risk of developing DM after pregnancy increases in those with GDM. All pregnant
women should be screened for GDM, regardless of risk factors.
How does it happen?

Increased maternal food consumption increases blood sugar levels

Hormones from the placenta (cortisol and insulinase) block the action of the insulin in the
mothers body (insulin resistance)
Insulin resistance makes it hard for the mother to use insulin
Without enough insulin, glucose cannot leave the blood and be used for energy
Glucose builds up in the blood (hyperglycemia)

How can GDM affect your baby?

Can lead to baby macrosomia, fat baby.

Baby has increase risk for obesity and for developing type 2 DM

Risk factors

Maternal age > 25 yrs

Previous macrosomic infant
Hx of intrauterine fetal demise (IUFD)
Previous pregnancy with GDM
Family hx of type 2 DM or GDM
Obesity

Signs and symptoms

Usually asymptomatic
Fatigue, thirst, increased urination, HA, nausea and vomiting, abdominal pain, drowsiness,
dim vision, rapid breathing (s/sx of hyperglycemia)

What can you do?

Standard diabetic diet to control blood glucose

o 30kcal/kg/day
o 25kcal/kg/day (obese)
Exercise helps lower blood glucose levels
Daily blood glucose checks to gauge progress
Medications
o Insulin
o Oral agents (glyburide)

Prevention
Early screening for GDM (24-28 wks of gestation)
If overweight, lower BMI before pregnancy may decrease risk for developing GDM
Eat a balanced, healthy diet

Reference: Lowerdmilk, D. (2014). Maternity nursing. (8th ed.). Maryland Heights, MO: Mosby Elsevier

Pathophysiology
Gestational Diabetes Mellitus

Fetal nutrients demands rise during

pregnancy, increasing maternal food
ingestion which leads to sustained
blood glucose levels

Maternal insulin resistance increases

due to antagonistic effects of placental
hormones cortisol and insulinase.

Maternal pancreas increases insulin

production to compensate for insulin
resistance.

Maternal pancreas unable to produce

enough insulin and glucose is not used
effectively.

Gestational diabetes can result which may

lead to a macrosomic baby if not
controlled. C section may be indicted.