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Copy of Gestational Diabetes Mellitus (GDM)

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Amjad M

on 27 May 2013

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Transcript of Copy of Gestational Diabetes Mellitus (GDM)

Antenatal Management Gestational Diabetes
Mellitus The world health organization defines it as carbohydrate intolerance resulting in hyperglycemia of
variable severity, with its onset or first recognition during pregnancy

(WHO 1999) Currently around 3.5% of
pregnancies in the U.K
are affected by Gestational diabetes mellitus (GDM) RISKS! AIM & Content Aim: To explore GDM in the Antenatal period of childbearing

Content:
what is diabetes?
what is Insulin?
What is GDM?
Changes in Pregnancy
Risks
Antenatal management
Screening for gestational diabetes
Role of the midwife in interprofessional team what is diabetes? Diabetes can be divided into four types :

Type 1- Insulin dependent
Type 2 - Non insulin dependent
Type 3- GDM
Type 4 – Secondary Risks and Complications of GDM Increased maternal glucose leads to an increased delivery of nutrients to the fetus,which stimulates fetal insulin production.

The potential effects on the baby include:
Polyhydramminos
Macrosomia also known as big baby syndrome
increased risk of shoulder dystocia
Intrauterine growth restriction (IUGR)
Neonatal hypoglycemia who has the GTT? The GTT checks how the body regulates sugar level in the blood.


For those at risk (See previous slide) between 26- 28weeks gestation.

if previous GDM
an additional GTT @ 16-18weeks What is GDM? diabetongenic state: Causing diabetes.


Pregnancy has long been termed a diabetogenic condition, primarily due to the physiological impacts of placental hormones (Bottalico,2007) Nina Narain
STO11 NPMS 2014 Gestational Diabetes Mellitus
GDM Gestational diabetes is associated with substantial rates of maternal and perinatal complications. Antenatal Care and Management Glycosuria


Random blood glucose



Glucose tolerance test (GTT) Screening Any questions? Diabetes is a common life-long health condition. There are over 2.9 million people diagnosed with diabetes in the UK and an estimated 850,000 people who have the condition but don’t know it. The word 'gestational' actually refers to 'during pregnancy' Why do women develop GDM? During pregnancy, the placenta's blood supply produces high levels of various hormones. Almost all of them impair the action of insulin in cells, raising blood sugar.

As the baby grows, the placenta produces more and more insulin-blocking hormones. In GDM, the placental hormones provoke a rise in blood sugar to a level that can affect the growth and welfare of the baby.


Gestational diabetes usually develops during the last half of pregnancy — sometimes as early as the 20th week, but usually not until later. Which is why we don't screen till 24-28weeks. Whats happening inside? Who is @ Risk? Risk factors for gestational diabetes (NICE 2008)
● Body mass index more than 30 kg/m²
● Previous macrosomic baby weighing 4.5 kg or more
● Previous gestational diabetes
● Family history of diabetes (first-degree relative with diabetes)
● Family origin with a high prevalence of diabetes:
❍ South Asian (specifically women whose country of family origin is India, Pakistan or
Bangladesh) Black Caribbean
❍ Middle Eastern (specifically women whose country of family origin is Saudi Arabia,United Arab Emirates, Iraq, Jordan, Syria, Oman, Qatar, Kuwait, Lebanon or Egypt) What is GDM? Antenatal Screening Midwifery Management identification
Diet
exercise
insulin?
labour and birth plan
future health advice
support throughout pregnancy
Work as part of a multi disciplinary team THE END! References Bandyopadhyay M, Small R, Davey MA, Oats JJ, and Forster DA, Aylward A (2011): Lived experience of gestational diabetes mellitus among immigrant South Asian women in Australia. Aust N Z J Obstet Gynaecol , 51(4):360-364.

Brody SC, Harris R, Lohr K. Screening for gestational diabetes:a summary of the evidence for the US PreventiveServices Task Force. Obstet Gynecol 2003; 101: 380–92.

Bottalico JN (2007) Recurrent gestational diabetes: Risk factors, diagnosis,management and implications. Semin Perinatol 31(3): 176–84

Coleman M and Soundararajan L (2012) ‘Diabetes through pregnancy and birth guideline’ university hospital Southampton version 4.0 (p1-39)

Crowther et al (2005) ‘effect of treatment of gestational diabetes mellitus on pregnancy outcomes’ the New England journal of medicine vol 352 NO.24

Dodd JM, Crowther CA, Antoniou G, Baghurst P, Robinson JS (2007) Screening for gestational diabetes: The effect of varying blood glucosedefinitions in the prediction of adverse maternal and infant health outcomes. Aust N Z J Obstet Gynaecol 47(4): 307–12

Evans MK and O’brien B (2005) Gestational diabetes: The meaning of an At-Risk pregnancy. Qualitative health research 15:66 accessed online 17/12/2012 http://www.sagepublications.com

Ekbom P, Damm P, Feldt-Rasmussen B, Feldt-Rasmussen U, JensenDM, Mathiesen ER (2008) Elevated third trimester haemoglobin A1C predicts preterm delivery in Type 1 diabetes. Journal of Diabetes and its Complications 22(5): 297–302

Fraser D and Cooper M (2009) Myles Textbook for midwives (15th ed) Elsiver

Gadamer, H. (1967/1976). On the scope and function of hermeneutical reflection. In D. Linger (ed) philiosophical hermeneutics Berkeley: university press (PP 18-44)

Hunt KJ, Schuller KL (2007) The increasing prevalence of diabetes in pregnancy, obstetrics and gynaecology clinics of North America. Obstet Gynecol Clin North Am 34(2): 173–99

Jevitt,C morse S o’donnell YS (2008) Shoulder dystocia: nursing prevention and post trauma care

Jane E Hirst,Thach S Tran, Forsyth Rowena, Jonathan M Morris and Heather E Jeffery (2012)Women with gestational diabetes in Vietnam: a qualitative study to determine attitudes and health behaviours BMC pregnancy and childbirth

National institute of clinical excellence (NICE) Diabetes in pregnancy CG63, London (2008)

S.E Robson and J Waugh (2008) ‘Medical disorders in pregnancy a manual for midwives’ (p82-83) Blackwell publishing’s.

World health organisation (WHO) Gestational Diabetes Mellitus accessed online 20/12/2012 http://www.who.int/topics/diabetes_mellitus/en/ Insulin Insulin is the hormone produced by the pancreas that allows glucose to enter the body’s cells, where it is used as fuel for energy so we can work, play and generally live our lives. It is vital for life. It is now the MOST common medical
disorder seen by Midwives. how it works? results If the result is
abnormal? contact diabetic midwife


who will arrange education, glucose monitoring and appropriate clinical review. recommend diet & exercise. Insulin: if CBG's are high, despite diet and exercise changes. oral tablets: NICE supports use of glibenclamide or metformin in pregnancy. It is our role as a Midwife to provide the correct
antenatal care for our women. At the booking interview we ask questions and can see who is at risk of GDM.

There are 3 points in the SUHT booking document to look at risks for GDM. GDM= diabetes or impaired glucose diagnosed for the first time in pregnancy. This definition encompasses women who develop diabetes as a result of their pregnancy AND women with pre-existing but undiagnosed diabetes (mainly type 2 diabetes) it is dependent on many genetic and environmental causation's.
(SUHT Guidelines 2012) Think of it like a car going into
a garage...... Car= Glucose
Garage = cell receptor
Garage key = Insulin Although GDM is a pregnancy-induced condition, it has been socially constructed as a disease state. For some women, being diabetic presented a negative stigma, was embarrassing and signified they were unhealthy

(Richard et al 2004) Psychological Implications Qualitative research As a midwife it is vital to understand the impact of GDM on the women we treat not only from a physical perspective but psychological implications of the disease. which my qualitative research and essay looks at .

Evans M and O'Brien B (2005) Gestational Diabetes : The meaning of an at-risk pregnancy. GDM is increasing and will be ever prevalent in our career's as midwives. It is our job to support our women and raise awareness throughout their pregnancy and future health risks. in conclusion Psychological Aspects
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