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Mother is risk for other complications: Increased risk of developing Gestational Diabetes again

Once a mother has developed gestational diabetes during one pregnancy, chances of having it again during subsequent pregnancies are more likely. Increased risk of Type 2 Diabetes

The chances are also increased of her developing type 2 diabetes as she grows older. Increased risk of preeclampsia

The mother has an increased risk of preeclampsia, which if left untreated is a potentially fatal disorder for both mother and her unborn child. Preeclampsia is characterized by high blood pressure and an excess of protein in the urine which occurs after the twentieth week of pregnancy. Premature birth

Women with Gestational Diabetes have an increased risk of entering premature/early labor. Increased likelihood of C-section birth

Because a baby born to a mother with gestational diabetes can be quite large, there is an increased chance that the child will need to be delivered by Caesarian section. Increased risk of developing high blood pressure. Hydramnios

Occurs about 10 times in women with GD Maternal dyspnea result from upward pressure on diaphragm by distended uterus PROM associated with hydramnios Over distention of uterus increase incidence of postpartum hemorrhage Infection

Disorder of carbohydrate metabolism alters the bodies normal resistance to infection. Vaginal infections are most common ( monilial vaginitis and UTI ) It increased insulin resistance and may result in ketoacidosis. Ketoacidosis

Occurs during second and third trimester when the diabetogenic effect of pregnancy is at greatest. Increased for hypoglycemia

Early in pregnancy hepatic production of glucose is diminished and peripheral use of glucose is enhanced and it occurs during sleep hours.

FETAL AND NEONATAL RISK: Sudden and unexplained stillbirth Congenital anomalies Central nervous and skeletal system

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What additional monitoring will be done on the fetus of a mother with gestational diabetes? Fetal Surveillance To assess fetal growth and well being. Its goal is to detect fetal compromise as early as possible and to prevent intrauterine fetal death. It repeats at 34 weeks. Baseline sonogram It is done on first trimester to assess gestational age. Ultrasound examination 4 to 6 weeks to monitor fetal weight, detect hydramnios, macrosomia and congenital anomalies. This test involves passing a special wand over the skin of the abdomen. Sound waves are transmitted into the body and bounce back, creating an image that shows the growth and development of the baby. Alpha-fetoprotein test This is a blood test that detects a particular protein produced by the baby's liver. Abnormal levels of alpha-fetoprotein (AFP) indicate a high risk for certain types of birth defects (neural tube defects). It is done on 16 18 weeks. Amniocentesis In this test, a long thin needle is inserted into the abdomen and a sample of amniotic fluid (the fluid that surrounds the baby within the uterus) is taken. Cells in the fluid help doctors determine if the baby's lungs are mature enough to withstand early delivery. Non-stress test A fetal monitor, strapped to the mother's abdomen, records the baby's heart rate for a short period of time. This reading helps doctors assess the health of the baby in the last weeks of pregnancy. It is done 28 32 weeks of gestation. After 32 weeks it is twice weekly done. Fetal monitoring During labor and delivery, a fetal monitor keeps constant track of the baby's heart rate in order to detect the first indications of distress.

Fetal echocardiography 18 22 weeks to detect cardiac anomalies Doppler studies of umbilical artery May be performed in women with vascular disease to detect placental maternal evaluation of fetal movements (kick counts) screening technique in fetal surveillance. 3. What additional preparation for delivery should be made for a woman with gestational diabetes? Gestational diabetes is managed: Monitoring blood sugar levels four times per day (before breakfast and 2 hours after meals. Monitoring blood sugar before all meals may also become necessary.) Monitoring urine for ketones (an acid that indicates your diabetes is not under control).

Following specific dietary guidelines as instructed by your doctor. You'll be asked to distribute your calories evenly throughout the day. Exercising after obtaining your health care provider's permission. Monitoring weight gain.

Taking insulin, if necessary. Insulin is currently the only diabetes medication used during pregnancy. Controlling high blood pressure.

ANTEPARTUM CARE o o o Achieving euglycemia Blood glucose level monitoring 2200 (first trimester) 2500 (2nd & 3rd trimester) Exercise It helps to reduce blood glucose level and maybe instrumental in eliminating need for insulin. o o o o Insulin Therapy Fetal Surveillance Daily bath, good perineal care and foot care is important Dietary modification

Eat three small meals and two or three snacks at regular times every day. Do not skip meals or snacks. Carbohydrates should be 40%-45% of the total calories with breakfast and a bedtime snack containing 15-30 grams of carbohydrates. If you have morning sickness, eat 1-2 servings of crackers, cereal, or pretzels before getting out of bed. Eat small, frequent meals throughout the day and avoid fatty, fried, and greasy foods. If you take insulin and have morning sickness, make sure you know how to treat low blood sugar. Choose foods high in fiber such as whole-grain breads, cereals, pasta, rice, fruits, and vegetables. All pregnant women should eat 20-35 grams of fiber a day. Fats should be less than 40% of calories with less than 10% consumed being from saturated fats. Drink at least 8 cups (or 64 ounces) of liquids per day. Make sure you are getting enough vitamins and minerals in your daily diet. Ask your health care provider about taking a prenatal vitamin and mineral supplement to meet the nutritional needs of your pregnancy. INTRAPARTUM CARE o Blood glucose level monitored

At least every 2 hours to maintain levels within a ranged will decreased severity of neonatal hypoglycemia. o o IV fluids with glucose is not given as a bolus. Routine uterine activity and fetal heart rate assessments.

POSTPARTUM CARE o Assessment of carbohydrate intolerance can be initiated 6 ot 12 weeks postpartum or after breastfeeding has stopped. o o Change lifestyle Exercise