Disease Affecting Pregnancy
Disease Affecting Pregnancy
Disease Affecting Pregnancy
DIABETES MELLITUS
- A chronic, metabolic disorder characterized by a deficiency in insulin production by the
Islets of Langerhans resulting in improper metabolic interaction of carbohydrates, fats,
proteins and insulin.
Incidence
- Maybe a concurrent disease in pregnancy or may have its first onset in pregnancy.
Risk Factors:
1. Family History
2. Rapid Hormonal Change in pregnancy
3. Tumor/infection of the pancreas
4. Obesity
5. Stress
Pathophysiology
Classification of Diabetes Mellitus
Type I Insulin Dependent
DM
Type II Non-Insulin
Dependent DM
Gestational DM
Gestational DM
- Carbohydrate intolerance of variable severity with onset or first recognition during
pregnancy.
Etiology
- Increased pancreatic stimulation associated with pregnancy and induced insulin
resistance impaired pancreatic beta cell function
Pathophysiology
- Hormones secreted by the placenta (hPL, progesterone, cortisol and prolactin) antagonize
insulin elevated blood glucose levels
Clinical Manifestations
- Glycusoria on 2 succesive consults
- Recurrent fungal vaginitis
- Ultrasound evidence of macrosomic fetus
Polyhydramnios
Diagnosing DM
1. Screening Test
a. Performed at 26 to 28 weeks gestation
b. Uses 50-g oral glucose challenge
c. Finding: A plasma glucose of 140mg/dL needs a follow up test with 3 hour
glucose tolerance test
2. Glucose Tolerance Test
a. Commonly done between 28 and 34 weeks of pregnancy. The presence of two out
of these four venous samples is considered abnormal result
i. FBS: >10mg/dL
ii. 1 hour after: serum glucose >190mg/dL
iii. 2 hours after: serum glucose >165mg/dL
iv. 3 hours after: serum glucose >145mg/dL
b. 2 hour Postprandial Blood Sugar (PPBS)
i. Abnormal result: >120mg/dL
c. Glycosylated Hemoglobin
i. Normal Value: 4% to 8%
Effects of DM on the Mother and the Baby
Mother
1. Infertility
2. Spontaneous Abortion
3. PIH
4. Infections: moniliasis, UTI
5. Uteroplacental Insuficiency
6. Premature labor
7. Dystocia
8. Caesarean section often indicated
9. Uterine atony
1.
2.
3.
4.
5.
6.
7.
8.
Baby
Congenital anomalies
Polyhydramnios
Macrosomia (LGA)
Fetal hypoxia intrauterine fetal death
(IUFD), still births; increased perinatal
mortality
Neonatal hypoglycemia (common as soon
as 1 hr after birth)
Prematurity
RDS (at 6th hr after birth)
Hypocalcemia
Nursing Implementation
1. Participate in early detection
a. History
b. Symptomatology
c. Perinatal screening
2. Encourage early prenatal management and supervision
a. Frequent, regular prenatal visit
b. Record dietary intake, monitor blood glucose levels several times daily
c. Insulin
d. Serial ultrasonography
e. Hospitalization
3. Provide teaching