Nursing Guide to Gestational Diabetes: Nursing Diagnosis, Interventions, & Care Plans

Gestational diabetes mellitus (GDM) is a type of diabetes that occurs during pregnancy when the body is unable to produce enough insulin to meet the increased demands. This leads to hyperglycemia, which can affect both the mother and the developing fetus. GDM typically develops in the second or third trimester and usually resolves after childbirth.  

However, women with gestational diabetes are at increased risk of developing type 2 diabetes later in life. Proper management through diet, exercise, blood glucose monitoring, and in some cases, insulin therapy, is essential to ensure a healthy pregnancy and reduce the risk of complications. 

Etiology and epidemiology 

Gestational diabetes is thought to occur due to the hormonal changes of pregnancy, which can make the body less responsive to insulin (insulin resistance). As the pregnancy progresses, the placenta produces hormones (such as human placental lactogen) that increase insulin resistance, requiring the pancreas to produce more insulin.  

In women with gestational diabetes, the pancreas is unable to meet this increased insulin demand, leading to elevated blood glucose levels. 

Risk factors: 

• Obesity: Women with a body mass index (BMI) of 30 or higher have a higher risk of developing GDM.
• Age: Women over 25 years of age have a higher risk.
• Family history of diabetes: A family history of type 2 diabetes increases the risk of GDM.
• History of gestational diabetes: Women who had GDM in previous pregnancies are more likely to develop it again.
• Ethnicity: Women of African American, Hispanic, Native American, and Asian descent are at higher risk.
• Polycystic ovary syndrome (PCOS): This condition is associated with insulin resistance, increasing the risk of GDM. 

Epidemiology: 

Gestational diabetes affects approximately 2-10% of pregnancies worldwide, with rates varying depending on population, diagnostic criteria, and risk factors. In the U.S., the prevalence of GDM has increased in recent decades, largely due to rising obesity rates. 

Gestational diabetes ICD-10 code 

The ICD-10 code for gestational diabetes is O24.4 – Gestational diabetes mellitus. 

Gestational Diabetes Diagnosis 

Gestational diabetes is typically diagnosed during routine prenatal screening between 24 and 28 weeks of gestation. Oral glucose tolerance test (OGTT): This is the most commonly used diagnostic test for GDM. After fasting overnight, the patient drinks a glucose solution, and blood glucose levels are measured at specific intervals (1, 2, or 3 hours post-ingestion). Elevated blood glucose levels at one or more intervals confirm the diagnosis. 

1. If the screening test is positive, a 100gm three hour oral glucose test is performed. 

Management 

The goal of management in gestational diabetes is to maintain normal blood glucose levels to avoid complications for both the mother and the fetus. This is achieved through lifestyle modifications and, if needed, medication. 

• Fasting or preprandial blood glucose values < 95 mg/dL
• Postprandial blood glucose values < 140 mg/dL at 1 hour and < 120 mg/dL at 2 hours

Lifestyle modifications: 

1. Diet: A balanced diet rich in complex carbohydrates, fiber, and lean proteins is recommended. Limiting simple sugars and refined carbohydrates helps control blood sugar. Women with GDM should eat small, frequent meals to prevent blood sugar spikes.
2. Exercise: Regular physical activity (e.g., walking, swimming, or prenatal yoga) helps improve insulin sensitivity and maintain healthy blood glucose levels. 

Blood glucose monitoring: 

Patients are advised to monitor their blood glucose levels several times a day, typically fasting and 1–2 hours after meals, to ensure that their blood sugar stays within the recommended target range. 

Medication: 

1. Insulin therapy: If blood glucose levels remain elevated despite lifestyle changes, insulin may be prescribed. It is the preferred medication during pregnancy, as it does not cross the placenta and is safe for the baby.
2. Oral hypoglycemic agents: In some cases, oral medications like metformin or glyburide may be used to manage blood sugar levels, although insulin remains the preferred treatment. 

Fetal monitoring: 

Regular fetal monitoring, including ultrasounds to assess growth, and non-stress tests, may be necessary to ensure that the baby is developing normally and to check for complications such as macrosomia (large birth weight). 

Gestational Diabetes nursing care plan 

Nursing considerations 

Nurses play a key role in educating patients about managing gestational diabetes, monitoring maternal and fetal well-being, and helping reduce the risk of complications. 

Assessment 

• Blood glucose levels: Regularly assess fasting and postprandial (after meals) blood glucose levels to determine if the patient is meeting glycemic targets.
• Nutritional status: Monitor the patient’s dietary intake, ensuring compliance with a healthy meal plan to control blood sugar.
• Weight gain: Track maternal weight gain throughout the pregnancy to ensure it falls within the recommended range based on pre-pregnancy BMI.
• Fetal monitoring: Regularly assess fetal growth and well-being through ultrasounds and fetal heart rate monitoring.
• Signs of complications: Monitor for signs of potential complications, such as preeclampsia, urinary tract infections, and excessive fetal growth. 

Nursing diagnosis/risk for 

• Risk for unstable blood glucose levels related to insulin resistance and increased glucose demands during pregnancy.
• Risk for fetal injury related to maternal hyperglycemia and potential complications such as macrosomia or neonatal hypoglycemia.
• Knowledge deficit related to gestational diabetes management, blood glucose monitoring, and diet control.
• Risk for imbalanced nutrition related to increased insulin resistance and difficulty maintaining appropriate blood glucose levels. 

Interventions 

• Blood glucose monitoring education: Teach patients how to use a glucometer to check blood glucose levels and explain the importance of recording these results for healthcare providers to review.
• Dietary education: Provide counseling on a gestational diabetes-friendly diet, emphasizing the importance of small, frequent meals, complex carbohydrates, and avoiding foods high in sugar.
• Medication administration: Instruct patients on how to administer insulin if prescribed, including proper injection techniques, storage, and when to administer it relative to meals.
• Exercise promotion: Encourage moderate, regular physical activity, such as walking, which helps control blood sugar levels and improve insulin sensitivity.
• Fetal monitoring support: Ensure that the patient understands the importance of regular prenatal visits for fetal monitoring, and explain any procedures, such as ultrasounds or non-stress tests. 

Expected outcomes 

• The patient will maintain blood glucose levels within the target range throughout the pregnancy.
• The patient will demonstrate understanding and adherence to dietary recommendations and blood glucose monitoring.
• The patient will remain free of complications related to gestational diabetes, such as preeclampsia or macrosomia.
• The fetus will show normal growth and development, as indicated by regular monitoring and appropriate birth weight. 

Individual/caregiver education 

• Blood glucose monitoring: Educate patients on the importance of checking blood sugar levels as directed and the target ranges for fasting and postprandial glucose.
• Diet and nutrition: Teach patients about the importance of a balanced, low-glycemic diet and provide examples of meals that will help keep blood sugar levels stable.
• Insulin administration: If insulin is prescribed, provide detailed instructions on how to self-administer the injections, where to inject, and how to store insulin safely.
• Signs of hyperglycemia and hypoglycemia: Educate patients on recognizing the symptoms of high (e.g., frequent urination, thirst) and low blood sugar (e.g., shakiness, dizziness) and how to manage these conditions.
• Postpartum follow-up: Inform patients that gestational diabetes usually resolves after childbirth, but follow-up testing at 6-12 weeks postpartum is essential to check for the development of type 2 diabetes. 

References 

1. American Diabetes Association: Gestational Diabetes Information
2. Mayo Clinic: Gestational Diabetes Overview
3. Centers for Disease Control and Prevention: Gestational Diabetes Facts
4. ICD-10 Data: O24.4 Gestational Diabetes Mellitus Updated ACOG Guidance on Gestational Diabetes - The ObG Project 

Resources 

• American Diabetes Association (ADA): Offers educational resources on managing gestational diabetes, including meal planning and glucose monitoring.
• Centers for Disease Control and Prevention (CDC): Provides information on the risk factors, prevention, and management of gestational diabetes.
• American College of Obstetricians and Gynecologists (ACOG): Shares clinical guidelines for the diagnosis and management of gestational diabetes during pregnancy.
• March of Dimes: Offers support and education for pregnant women managing gestational diabetes and related complications.