The common definition of gestational diabetes mellitus (GDM) is glucose or carbohydrate intolerance with onset, first recognition or first diagnosis during pregnancy; it is a common complication in pregnancy that typically ends a few weeks after birth (Coustan, 2013; Zhang & Ning, 2011; Brown, 2011). Although the causes of GDM are not known, it appears that hormones from the placenta lead to insulin resistance in the mother; this insulin resistance combined with an inadequate insulin secretion to compensate for its resistance has a central role in the pathophysiology of GDM, which can then lead to hyperglycemia and gestational diabetes mellitus (Zhang & Ning, 2011; Blake, Munoz, & Volpe, 2014). It is thought that women who develop GDM …show more content…
2014; Zhang & Ning, 2011; Tobias, et al., 2012).
Diagnosis and management of gestational diabetes According to Blake (2011) glucose screening is recommended for women at high risk (including the risk factors mentioned above) for gestational diabetes, but is not recommended for certain women; women who are: under the age of 25, no first degree familial diabetes, normal pre-pregnancy weight and healthy pregnancy weight gain, no history of glucose intolerance, and no previously poor outcomes obstetrically. In comparison, the American College of Obstetricians and Gynecologists (ACOG) endorses universal screening of all pregnant women for gestational diabetes mellitus (GDM) (Coustan 2013). The usual screening test used for GDM is a 50-gram 1-hour glucose challenge (50-gram oral glucose test) at 24-28 weeks gestation (Coustan 2013; Brown, 2011). This one hour glucose test is used as the initial screening tool to identify potential cases that may need further testing; further testing is required if the glucose level is greater than or equal to 130 mg/dL (Brown, 2011). The first test is followed up with either the 100-g/3-h oral glucose tolerance test (OGTT) or the 75-g/2-h OGTT; the OGTT is usually performed by giving a pregnant woman a drink containing
Along with all the worries and complications a woman might face while pregnant, one of the more serious conditions is gestational diabetes. Gestational diabetes occurs in 4% of all pregnancies (Seibel, 2009). Many women are not informed about the disease, some may not know that they need to be tested, and others may have heard about it, but want more information on what may cause it and/or how to prevent and treat it. Either way this disease needs to be taken seriously by every pregnant woman or woman planning to get pregnant to protect not only herself but the unborn child.
Amanda manages her gestational diabetes with diet. She experiences a few episodes of postprandial hyperglycemia, but does not have to go on insulin. At her 36-week
It is estimated that 387 million people, globally live with diabetes (Phillips & Mehl, 2015). According to Medical News Today [MNT], diabetes is a metabolic disorder; which causes patients to be extremely thirsty and produce a lot of urine. Diabetes arises due to high blood pressure, due to the body not being able to produce enough insulin or because the body does not respond well to high insulin levels (MNT, 2016). There are four types of diabetes; there is the pre-diabetic stage, type 1 diabetes, type 2 diabetes and gestational diabetes. In 2014, 29 million people died due to diabetes. This equates to 1 diabetic patient dying every seven seconds due to preventable complications (including complications affecting lower limbs) caused by diabetes. It is said that 20-40% of health care costs are spent on the treatment of lower limb complications due to diabetes. The risk of a diabetic patient developing a foot ulcer is 25% and foot ulcers account approximately 85% of lower limb amputations. Diabetic complications that affect lower limbs are caused by both type 1 and type 2 diabetes (Phillips & Mehl, 2015). It is said that the World Health Organization described diabetic foot syndrome as including all possible complications in relation to the feet of a diabetic patient. Diabetic foot syndrome is defined as the ulceration of the foot, from the ankle downwards. Causes of foot ulceration include peripheral sensory neuropathy, vascular disease (ischaemia) and infection
The Gestational Diabetes Act is a bill that amends the Public Health Service Act (Congress.gov., 2015). This act emphasizes on the National Vital Statistics System, the National Center for Health Statistics, and State health departments to monitor and collect data on GDM. Regarding babies born from mothers with GDM, those diagnosed and undiagnosed with GDM. Finding ways to track and monitor postpartum women with GDM, implementing interventions that are culturally sensitive to reduce the risk of developing GDM and complications. The act also focuses on clinical and public health research on GDM to find interventions for women with a history of GDM from developing DM II as well as their children. Research on understanding GDM regarding risk
Women with GDM are at elevated risk for numerous maternal health complications, and their infants are at elevated risk for death and morbidity. (Dye, Knox, Artal, Aubry, & Wojtowycz, 1997)It developed in one out of twenty five pregnancies worldwide. Frequently it occurs in African Americans, Hispanic/Latino Americans, American Indians, and people with a family history of diabetes than in other groups. It usually disappears after pregnancy, but the mother and the child are at big risk of developing type two diabetes.
Gestational diabetes, which is much less common, only occurs during pregnancy and is caused by a resistance to the actions of insulin brought on by the hormones a woman’s body releases during pregnancy (WHO 2011, p. 2). Once diagnosed with gestational diabetes mellitus you are at a greater risk of developing type 2 diabetes later in life (Zimmet & Magliano 2011). For this reason it is particularly important to use preventative measures and consistent health checks.
“Diabetes Mellitus is a disease that is characterized by chronic hypoglycemia” (ATI 2011). There are three classifications of Diabetes; Type One is classified as "juvenile-onset" or "insulin-dependent" diabetes. This type of diabetes does is where the immune system destroys cells that release insulin, eliminating the production of insulin in the body. Without insulin, cells can 't absorb the sugar in the body; sugars are used to make energy by the body. Secondly, Type Two diabetes is classified as "adult-onset" or "non-insulin dependent diabetes. This type of diabetes can develop at any age, and is usually based on lifestyle choices. In Type Two, the body isn’t able to make use of the insulin that is currently being produced, which is classified as resistance of insulin. As this disease progresses, the pancreas will produce less insulin, causing a deficiency. Thirdly, Gestational diabetes occurs in pregnancy. It is situational diabetes when the development of the fetus blocks the production of insulin by the pancreas.
RESEARCH ARTICLE: Rowan J., Gao W., Battin M., & Moore M. (2008). Metformin Vs. Insulin for the Treatment of Gestational Diabetes. The New England Journal of Medicine. 358(19):2003-2015.
Diabetes has been established to be more precarious for women, as it can augment pregnancy complications such as macrosomia, miscarriage, and birth defects. Women with diabetes also have a higher prevalence of secondary cardiovascular disease. Among those women who continue in the spiral of diabetes complications, ischemic heart disease is an even greater complication which will reduce survival and quality of life (Beckles and Thompson-Reid, 2011). Pregnant women diagnosed with gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes later in their lifetime. It has been proven that an average of 25 percent of pregnant women with GDM will be diagnosed with type 2 diabetes within an average of seven years (Sokup, Ruszkowska-Ciatec, Walentowicz, Grabiec & Rose, 2014). In such women, blood glucose and triglyceride levels must be monitored closely, and appropriate action and referrals are given if needed for proper disease management.
Gestational Diabetes: This is often found in pregnant women who have never had an incidence of high blood sugar or a history of diabetes. It is characterized by high levels of blood glucose during pregnancy but normal blood glucose levels after pregnancy if controlled right (WHO,
This exposure to high levels of glucose can lead to high levels of fetal insulin production, both of which are a danger to the baby brain (Davis Health 2012). Additionally, these levels may lead to a lack of oxygen to the fetus, known as fetal hypoxia (Krakowiak et al 2012). This is known to affect brain structure, particularly the hippocampus and neural myelination (Krakowiak et al 2012). Women who have difficulties regulating their glucose levels prior to becoming pregnant often develop gestational diabetes mellitus, which only appears during pregnancy (Krakowiak et al 2012). More than 85 percent of maternal diabetes cases pertain to gestational diabetes mellitus, or GDM (Xu et al 2014). Though gestational diabetes is the most common form of diabetes during/ pregnancy, preexisting type 1 and type 2 diabetes still appear, together only accounting for 12.5 percent of maternal diabetes cases, and can also affect the growing fetus (Xu et al 2014).
For those who have gestational diabetes or are newly pregnant, having a strong support group and a care team is very crucial in preventing and reducing this disease. Two strategies that have been found to be effective in treating GDM is to follow a healthy diet and to fully participate in prenatal care. Nutritional therapy is a stepping-stone of having a healthy
Insulin is the only hormone in the body that lowers blood glucose levels, as it targets cells and provides for glucose storage as glycogen (Mattson Porth, 2002). Insulin prevents fat and glycogen breakdown and inhibits glycogenesis and increases portent synthesis (Mattson Porth, 2002). The placenta secretes hormones and adipokines, these include tumor necrosis factor (TNF)-α, human placental lactogen, and human placental growth hormone (Alfadhli, 2015). Furthermore, increased oestrogen, progesterone and cortisol during pregnancy add to the disruption of the balance of glucose and insulin levels within the body (Alfadhli, 2015). The body tries to compensate for the insulin resistance by increasing the amount of insulin that is secreted, however women with gestational diabetes can not secrete enough insulin to keep up with the metabolic stress of the insulin resistance causing hyperglycaemia in the bloodstream (Alfadhli, 2015).
Pregnancy institutes a state of insulin resistance and hyperinsulinemia, a condition involving the increase of insulin circulating in the blood(Association, 2004). This altered state predisposes some women to form a degree of glucose intolerance with onset that was otherwise not recognized preceding pregnancy (Association, 2004; Gilmartin, Ural, & Repke, 2008; Kaaja & Rönnemaa, 2008). This form of intolerance is referred to as Gestational Diabetes Mellitus (GDM). GDM stems from a variety of factors ranging from human chorionic somatomammotropin (HCS) secretion and estrogen disruption, but this study will focus on Glucocorticoid (GC) secretion (Kaaja & Rönnemaa, 2008). GCs are steroids that have potent immunosuppressive and anti-inflammatory properties (Munck, Guyre, & Holbrook, 1984). Cortisol is a naturally occurring GC as well as the end-product of the hypothalamic-pituitary-adrenal (HPA) axis, the body’s central stress response(Jozic, Stojadinovic, Kirsner, & Tomic-Canic, 2015). HPA axis activity is characterized by the release of hypothalamic corticotrophin-releasing factor (CRF), also referred to as corticotrophin- releasing hormone (CRH). When CRF binds to the CRF receptors on the anterior pituitary gland it stimulates the biosynthesis and release of adrenocorticotropic hormone (ACTH)(Munck et al., 1984). Released ACTH binds to adrenal cortex receptors triggering cortisol production and release. During pregnancy, regulation of the HPA changes at a drastic rate (Maeyama
Gestational diabetes mellitus (GDM) is an intolerance of glucose documented for the first time during pregnancy. It is usually a short-term type of diabetes and the most common health problem with pregnant women. GBM is caused by the way the hormones in pregnancy affect the mother. GDM accounts for 5-7% of all pregnancies (American Diabetes Association, 2010). During pregnancy the placenta develops and becomes the main bond between the mother and the baby. It is used to make sure the baby has and gets enough nutrients. The placenta makes several hormones which make it hard for insulin to control blood glucose and block the action of the mother’s insulin in her body (American Diabetes Association, 2010). Hormonal changes during the