Gestational Diabetes Lecture Notes | Lecture notes Nursing

During pregnancy, especially in the second trimester,

the body can become less responsive to insulin,

which is called insulin resistance. This means that the

body has to produce more insulin to keep blood sugar

levels normal. Several hormones contribute to this

insulin resistance:

1. Progesterone: A hormone that helps maintain

pregnancy but can also reduce the body's sensitivity to

insulin.

2. Cortisol: Known as the "stress hormone," it can raise

blood sugar levels and make the body less responsive

to insulin.

3. Human placental lactogen: A hormone produced by

the placenta that helps the baby grow but also

contributes to insulin resistance by making it harder

for the body to use insulin effectively.

4. Prolactin and estrogen: These hormones also play a

role in the changes during pregnancy and contribute

to insulin resistance to some extent.

The placental insulinase enzyme is an enzyme

produced by the placenta during pregnancy. Its job is

to break down insulin in the bloodstream. This helps

regulate the levels of insulin, which is important

because insulin is a hormone that controls blood

sugar. However, in pregnancy, the placenta produces

more of this enzyme, which can lead to higher blood

sugar levels by breaking down insulin more quickly.

When obesity is involved, it can make this situation

worse. People who are obese often have higher levels

of insulin to begin with, because their body needs

more insulin to keep their blood sugar levels in

check. When the placental insulinase enzyme breaks

down insulin faster during pregnancy, it can make it

even harder for obese women to maintain normal

insulin levels. This can lead to higher blood sugar

levels, which increases the risk of gestational

diabetes.

In simple terms, the placental insulinase enzyme

breaks down insulin, and when someone is obese, this

can make it even harder for their body to keep blood

sugar under control during pregnancy.

For women with gestational diabetes or overt

diabetes during pregnancy, managing weight gain is

important for both the health of the mother and the

baby. The weight gain targets can vary based on

factors like pre-pregnancy weight, type of diabetes,

and overall health. Here are general guidelines:

1. Gestational Diabetes:

For women who develop gestational diabetes

(diabetes that develops during pregnancy), weight

gain should be monitored closely to help control

blood sugar levels. The target weight gain is typically

based on pre-pregnancy BMI (Body Mass Index):

Underweight (BMI less than 18.5): Gain 28-40 pounds

(12.5-18 kg)

Normal weight (BMI 18.5-24.9): Gain 25-35 pounds

(11.5-16 kg)

Overweight (BMI 25-29.9): Gain 15-25 pounds (7-11

kg)

Obese (BMI 30 or higher): Gain 11-20 pounds (5-9 kg)

Women with gestational diabetes should aim for the

lower end of the recommended weight gain range,

focusing on maintaining healthy blood sugar levels

through diet and exercise.

2. Overt Diabetes (Type 1 or Type 2

Diabetes) Before Pregnancy:

For women with pre-existing diabetes (type 1 or

type 2) who become pregnant, weight gain is also

important to monitor. However, since they already

have diabetes, controlling blood sugar through

medication (insulin or other treatments) is critical.

Here are some guidelines for weight gain:

Underweight (BMI less than 18.5): Gain 28-40 pounds

(12.5-18 kg)

Normal weight (BMI 18.5-24.9): Gain 25-35 pounds

(11.5-16 kg)

Overweight (BMI 25-29.9): Gain 15-25 pounds (7-11

kg)

Obese (BMI 30 or higher): Gain 11-20 pounds (5-9 kg)

However, some studies suggest that women with pre-

existing diabetes may gain less weight during

pregnancy, and that careful monitoring is important

to avoid excessive weight gain, which can increase

the risk of complications like high blood pressure,

preeclampsia, and macrosomia (a large baby).

General Guidelines:

Gradual weight gain: Weight should be gained

gradually throughout pregnancy, with the most weight

gained in the second and third trimesters.

Diet and exercise: Women with diabetes should focus

on a balanced diet with controlled carbohydrates and

regular physical activity (as recommended by their

healthcare provider) to help manage blood sugar

levels while staying within the recommended weight

gain target.

Always remember, it's essential to consult with a

healthcare provider or a specialist in pregnancy with

diabetes to personalize weight gain targets, as

individual health factors will influence the plan.

Blood glucose-lowering pharmacological therapy

during pregnancy is used when lifestyle changes

(such as diet and exercise) are not enough to manage

blood sugar levels. The main goal is to maintain

blood sugar levels within a healthy range to protect

both the mother and the baby from complications.

Here’s an overview of the medications commonly

used:

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During pregnancy, especially in the second trimester,

the body can become less responsive to insulin,

which is called insulin resistance. This means that the

body has to produce more insulin to keep blood sugar

levels normal. Several hormones contribute to this

insulin resistance:

1. Progesterone : A hormone that helps maintain

pregnancy but can also reduce the body's sensitivity to insulin.

2. Cortisol : Known as the "stress hormone," it can raise

blood sugar levels and make the body less responsive to insulin.

3. Human placental lactogen : A hormone produced by

the placenta that helps the baby grow but also contributes to insulin resistance by making it harder for the body to use insulin effectively.

4. Prolactin and estrogen : These hormones also play a

role in the changes during pregnancy and contribute to insulin resistance to some extent.

The placental insulinase enzyme is an enzyme

produced by the placenta during pregnancy. Its job is

to break down insulin in the bloodstream. This helps

regulate the levels of insulin, which is important

because insulin is a hormone that controls blood

sugar. However, in pregnancy, the placenta produces

more of this enzyme, which can lead to higher blood

sugar levels by breaking down insulin more quickly.

When obesity is involved, it can make this situation

worse. People who are obese often have higher levels

of insulin to begin with, because their body needs

more insulin to keep their blood sugar levels in

check. When the placental insulinase enzyme breaks

down insulin faster during pregnancy, it can make it

even harder for obese women to maintain normal

insulin levels. This can lead to higher blood sugar

levels, which increases the risk of gestational

diabetes.

In simple terms, the placental insulinase enzyme

breaks down insulin, and when someone is obese, this

can make it even harder for their body to keep blood

sugar under control during pregnancy.

For women with gestational diabetes or overt

diabetes during pregnancy, managing weight gain is

important for both the health of the mother and the

baby. The weight gain targets can vary based on

factors like pre-pregnancy weight, type of diabetes,

and overall health. Here are general guidelines:

1. Gestational Diabetes:

For women who develop gestational diabetes

(diabetes that develops during pregnancy), weight

gain should be monitored closely to help control

blood sugar levels. The target weight gain is typically

based on pre-pregnancy BMI (Body Mass Index) :

 Underweight (BMI less than 18.5) : Gain 28-40 pounds (12.5-18 kg)  Normal weight (BMI 18.5-24.9) : Gain 25-35 pounds (11.5-16 kg)  Overweight (BMI 25-29.9) : Gain 15-25 pounds (7- kg)  Obese (BMI 30 or higher) : Gain 11-20 pounds (5-9 kg)

Women with gestational diabetes should aim for the

lower end of the recommended weight gain range,

focusing on maintaining healthy blood sugar levels

through diet and exercise.

2. Overt Diabetes (Type 1 or Type 2

Diabetes) Before Pregnancy:

For women with pre-existing diabetes (type 1 or

type 2) who become pregnant, weight gain is also

important to monitor. However, since they already

have diabetes, controlling blood sugar through

medication (insulin or other treatments) is critical.

Here are some guidelines for weight gain:

However, some studies suggest that women with pre-

existing diabetes may gain less weight during

pregnancy, and that careful monitoring is important

to avoid excessive weight gain, which can increase

the risk of complications like high blood pressure,

preeclampsia, and macrosomia (a large baby).

General Guidelines:

 Gradual weight gain : Weight should be gained gradually throughout pregnancy, with the most weight gained in the second and third trimesters.  Diet and exercise : Women with diabetes should focus on a balanced diet with controlled carbohydrates and regular physical activity (as recommended by their healthcare provider) to help manage blood sugar levels while staying within the recommended weight gain target.

Always remember, it's essential to consult with a

healthcare provider or a specialist in pregnancy with

diabetes to personalize weight gain targets, as

individual health factors will influence the plan.

Blood glucose-lowering pharmacological therapy

during pregnancy is used when lifestyle changes

(such as diet and exercise) are not enough to manage

blood sugar levels. The main goal is to maintain

blood sugar levels within a healthy range to protect

both the mother and the baby from complications.

Here’s an overview of the medications commonly

used:

1. Insulin

Insulin is the first-line treatment for controlling

blood glucose in pregnant women, particularly those

with gestational diabetes or pre-existing type 1 or

type 2 diabetes. Insulin does not cross the placenta,

so it is considered safe for both the mother and baby.

 Types of insulin used : o Rapid-acting insulin : This works quickly to lower blood glucose after meals. o Short-acting insulin : This also lowers blood glucose after meals but works a little slower than rapid-acting insulin. o Intermediate-acting insulin : This provides a steady level of insulin for several hours. o Long-acting insulin : It helps control blood glucose levels over a longer period, often used to keep blood sugar steady throughout the night.

Insulin therapy is often adjusted based on daily

blood sugar monitoring and may be given multiple

times a day (as injections or via an insulin pump).

2. Metformin

Metformin is an oral medication that is commonly

used to treat type 2 diabetes. It works by reducing

the amount of glucose produced by the liver and

improving how the body responds to insulin.

 Use in pregnancy : o It is sometimes used in gestational diabetes when insulin therapy is not immediately needed. Some studies suggest that metformin may be effective and safe for use in pregnancy, but it should only be prescribed by a doctor. o Metformin can be used alone or in combination with insulin, depending on the individual case.

3. Glyburide (Glibenclamide)

Glyburide is an oral medication that helps the body

release more insulin and improves how the body uses

insulin. It can be used to manage gestational

diabetes.

 Use in pregnancy : o Some studies suggest that glyburide can be effective in managing blood sugar levels in pregnancy. However, it is less commonly used than insulin, as insulin is the preferred treatment. It can be considered for women who cannot take insulin or prefer oral medication. o It does cross the placenta, so it needs to be used with caution and under medical supervision.

4. Acarbose

Acarbose is another oral medication that slows the

breakdown of carbohydrates in the digestive system,

leading to a slower release of glucose into the

bloodstream.

 Use in pregnancy : o Acarbose is not typically recommended during pregnancy because there is limited safety data available. It's generally avoided in favor of insulin or metformin.

Important Considerations:

 Blood glucose monitoring : Women taking any of these medications will need to closely monitor their blood glucose levels to ensure they stay within the recommended range.  Diet and exercise : Even with medication, lifestyle changes like healthy eating and regular physical activity remain an essential part of managing blood glucose levels during pregnancy.  Healthcare provider consultation : Any medication used during pregnancy must be prescribed and closely monitored by a healthcare provider, as the health of both the mother and the baby is a priority.

Summary :

 Insulin is the primary treatment for blood glucose control during pregnancy.  Metformin and glyburide can sometimes be used as alternatives to insulin, especially for women with gestational diabetes.  All medications should be carefully monitored by a doctor to ensure safety and effectiveness.

HbA1c , also known as glycated hemoglobin , is a

blood test that provides an average of a person's

blood sugar levels over the past 2 to 3 months. It's

commonly used to diagnose and monitor diabetes.

Here's a simple explanation:

 What is it? o Hemoglobin is a protein in red blood cells that carries oxygen. o When blood sugar (glucose) is in the bloodstream, some of it attaches to the hemoglobin in the red blood cells. The higher the blood sugar, the more glucose will attach to the hemoglobin. o HbA1c is a measure of how much glucose is attached to the hemoglobin. It's expressed as a percentage.

Why is it important?

 For diabetes diagnosis : A high HbA1c level can indicate diabetes or prediabetes.  For monitoring diabetes : People with diabetes use HbA1c levels to monitor how well their blood sugar is controlled over time.

Gestational Diabetes Lecture Notes, Lecture notes of Nursing

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Partial preview of the text

Download Gestational Diabetes Lecture Notes and more Lecture notes Nursing in PDF only on Docsity!

During pregnancy, especially in the second trimester,

the body can become less responsive to insulin,

which is called insulin resistance. This means that the

body has to produce more insulin to keep blood sugar

levels normal. Several hormones contribute to this

insulin resistance:

1. Progesterone : A hormone that helps maintain

2. Cortisol : Known as the "stress hormone," it can raise

3. Human placental lactogen : A hormone produced by

4. Prolactin and estrogen : These hormones also play a

The placental insulinase enzyme is an enzyme

produced by the placenta during pregnancy. Its job is

to break down insulin in the bloodstream. This helps

regulate the levels of insulin, which is important

because insulin is a hormone that controls blood

sugar. However, in pregnancy, the placenta produces

more of this enzyme, which can lead to higher blood

sugar levels by breaking down insulin more quickly.

When obesity is involved, it can make this situation

worse. People who are obese often have higher levels

of insulin to begin with, because their body needs

more insulin to keep their blood sugar levels in

check. When the placental insulinase enzyme breaks

down insulin faster during pregnancy, it can make it

even harder for obese women to maintain normal

insulin levels. This can lead to higher blood sugar

levels, which increases the risk of gestational

diabetes.

In simple terms, the placental insulinase enzyme

breaks down insulin, and when someone is obese, this

can make it even harder for their body to keep blood

sugar under control during pregnancy.

For women with gestational diabetes or overt

diabetes during pregnancy, managing weight gain is

important for both the health of the mother and the

baby. The weight gain targets can vary based on

factors like pre-pregnancy weight, type of diabetes,

and overall health. Here are general guidelines:

1. Gestational Diabetes:

For women who develop gestational diabetes

(diabetes that develops during pregnancy), weight

gain should be monitored closely to help control

blood sugar levels. The target weight gain is typically

based on pre-pregnancy BMI (Body Mass Index) :

Women with gestational diabetes should aim for the

lower end of the recommended weight gain range,

focusing on maintaining healthy blood sugar levels

through diet and exercise.

2. Overt Diabetes (Type 1 or Type 2

Diabetes) Before Pregnancy:

For women with pre-existing diabetes (type 1 or

type 2) who become pregnant, weight gain is also

important to monitor. However, since they already

have diabetes, controlling blood sugar through

medication (insulin or other treatments) is critical.

Here are some guidelines for weight gain:

However, some studies suggest that women with pre-

existing diabetes may gain less weight during

pregnancy, and that careful monitoring is important

to avoid excessive weight gain, which can increase

the risk of complications like high blood pressure,

preeclampsia, and macrosomia (a large baby).

General Guidelines:

Always remember, it's essential to consult with a

healthcare provider or a specialist in pregnancy with

diabetes to personalize weight gain targets, as

individual health factors will influence the plan.

Blood glucose-lowering pharmacological therapy

during pregnancy is used when lifestyle changes

(such as diet and exercise) are not enough to manage

blood sugar levels. The main goal is to maintain

blood sugar levels within a healthy range to protect

both the mother and the baby from complications.

Here’s an overview of the medications commonly

used:

1. Insulin