TOPIC: GESTATIONAL DIABETES in Pregnancy
Discuss 1) Etiology, 2) Epidemiology, 3) Pathophysiology, 4) Clinical Manifestations, 5) Clinical Work-up, 6) Nonpharmacological and 7) Pharmacological management, 8) Education, and 9) Follow-up for a Gestational Diabetes in pregnancy. 500 words or less for the initial post.
Length: A minimum of 500 words, not including references
Citations: At least 2 high-level scholarly reference in APA-7 from within the last 5 years
Gestational diabetes is a high blood sugar that progresses during the pregnancy and generally disappears after birth. It may occur at any pregnancy stage, but it is more common in second or third trimesters (Saravanan et al.,2020).
During pregnancy, the mother’s placenta produces hormones that cause the glucose to accumulate in the blood. Usually, the pancreas may produce sufficient insulin to handle it. But then again, if the body cannot produce enough insulin or stop using it as required, blood sugar levels increase, and one gets gestational diabetes.
Gestational diabetes in pregnancy is often defined as pregnancy’s most common metabolic condition, increasing at epidemic proportions. Though, reported occurrence worldwide differs between 1 and 45 percent of pregnancies. Every year, 2‑10% of pregnancies in the U.S are affected by gestational diabetes.
Gestational diabetes in pregnancy usually results from the β-cell dysfunction in the context of resistance to chronic insulin during the pregnancy. Therefore, both the β-cell damage and tissue insulin resistance signify serious mechanisms of this condition (Plows et al.,2019). β-cell dysfunction is worsened by insulin resistance. Minimized insulin-stimulated uptake of glucose further contributes to hyperglycemia, overloading β-cells that have to form more insulin as a result. A direct influence of the glucose to failure of β-cell is called glucotoxicity. Therefore, after a β-cell dysfunction starts, vicious series of hyperglycemia, insulin resistance, and more β-cell dysfunction are set in motion.
The clinical manifestations include extreme thirst, a recurrent, large volume of urination, tiredness, sugar in the urine, blurred vision, numerous bladder, skin, or vaginal infections, and nausea.
Clinical Work Up
FPG of 126 mg/dL or high, untimed random plasma glucose of 200 mg/dL or high (≥11.1 mmol/L), or HbA1c of 6.5 percent or higher shows evident diabetes (type 1, 2, or other), whereas an FPG of 92 to 125 mg/dL shows gestational diabetes.
Non-pharmacological management may include monitoring the levels of blood glucose. Patients can monitor their levels of blood glucose at home to ensure that the management of gestational diabetes is keeping their levels of blood glucose within the target range. This is to guarantee suitable treatment may be directed and changed as required. Also, healthcare provider recommends adopting healthy eating pattern. This remains an essential part of managing gestational diabetes. For instance, blood glucose levels are maintained within the target range advised by the doctor, and adequate nutrition is provided for the mother and the growing baby. Besides, the physician can recommend physical activity as it helps reduce insulin resistance.
This may include insulin injections that remain a standard medication. The healthcare provider might prescribe fast-acting insulin before every meal, or intermediate- or long-acting insulin is taken during bedtime or on waking up. In addition to insulin, the care provider can prescribe oral medication like Glynase, Micronase or Diabeta or Glucophage Fortamet, or Metformin.
The patient can be enlightened to focus on healthy meal plans often suggested by a registered dietician and regular exercises (Allehdan et al.,2019). The diets here would focus on foods rich in fiber and other significant nutrients and low calories and fats. For instance, vegetables, whole grains and fruits, and refined carbohydrates counting sugar. Regular physical activity such as walking helps increase patient fitness, preparing them for the baby’s birth. Physical activity similarly helps manage the levels of blood glucose.
Follow-up may involve patients getting tested for diabetes 6‑12 weeks after the baby is born and again every 1to three years.
Allehdan, S. S., Basha, A. S., Asali, F. F., & Tayyem, R. F. (2019). Dietary and exercise interventions and glycemic control and maternal and newborn outcomes in women diagnosed with gestational diabetes: a systematic review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 13(4), 2775-2784. https://doi.org/10.1016/j.dsx.2019.07.040
Plows, J. F., Reynolds, C. M., Vickers, M. H., Baker, P. N., & Stanley, J. L. (2019). Nutritional supplementation for the prevention and treatment of gestational diabetes mellitus. Current diabetes reports, 19(9), 1-15. Doi: 10.3390/ijms19113342
Saravanan, P., Magee, L. A., Banerjee, A., Coleman, M. A., Von Dadelszen, P., Denison, F., … & Maternal Medicine Clinical Study Group. (2020). Gestational diabetes: opportunities for improving maternal and child health. The Lancet Diabetes & Endocrinology, 8(9), 793-800. https://doi.org/10.1016/S2213-8587(20)30161-3