Pregnancy Complications - 5

Gestational Diabetes

It is a glucose intolerance that is first recognized in pregnancy.

Clinical Findings

• Polyuria
• Polydipsia
• Polyphagia
• Fatigue
• Blurred vision
• Glucosuria
• Recurrent yeast infections
• Slow healing wounds
• Abnormal glucose results
• 1-hour glucose 140 mg/dL
• Abnormal 3-hour glucose tolerance test: 2 out of 4 values elevated
• FBS 95mg/dL
• 1-hour 180mg/dL
• 2-hour 155mg/dL
• 3-hour 140mg/dL

Outpatient Management

1. Dietician consult for ADA diet instructions
2. Discuss pathophysiology of gestational diabetes with patient
3. Demonstrate home glucose monitoring
4. Review range for glycemic control
5. Demonstrate logging of glucose results
6. Discuss role of exercise in glycemic control
7. Demonstrate urine ketone testing
8. Demonstrate insulin administration
9. Teach patient to count fetal movements
• Find comfortable position in quiet place and concentrate on fetal movement
• Document time of first fetal movement and time required for 10 movements (should not take more than 2 hours)
• If pattern of movement decreased, REPORT immediately