Gestational Diabetes Nursing Care Plan & Management


  1. Gestational diabetes is abnormal carbohydrate, fat, and protein metabolism that is first diagnosed during pregnancy, regardless of the severity.
  2. Gestational diabetes is further classified as:
    • Gestational diabetes characterized by an abnormal glucose tolerance test (GTT) without other symptoms. Fasting glucose is normal and the diabetes is controlled by diet (A1).
    • Gestational diabetes characterized by abnormal glucose tolerance test and elevated fasting glucose. This type of gestational diabetes must be controlled by insulin (A2).
  3. About 15,000 infants are born to mothers with diabetes each year. Since 1980, the International Workshop-Conference on gestational Diabetes and the American Diabetic Association has recommended universal screening for gestational diabetes between 24 and 28 weeks of gestation.
  • Gestational diabetes is a disorder of late pregnancy (typically), caused by the increased pancreatic stimulation associated with pregnancy.
  1. In gestational diabetes mellitus (type III, GDM), insulin antagonism by placental hormones, human placental lactogen, progesterone, cortisol, and prolactin leads to increased blood glucose levels. The effect of these hormones peaks at about 26 weeks’ gestation. This is called the diabetogenic effect of pregnancy.
  2. The pancreatic beta cell functions are impaired in response to the increased pancreatic stimulation and induced insulin resistance.
  3. Pregnancy complicated by diabetes puts the mother at increased risk for the development of complications, such as spontaneous abortion, hypertensive disorders, and preterm labor, infection, and birth complications.
  4. The effects of diabetes on the fetus include hypoglycemia, hyperglycemia, and ketoacidosis. Hyperglycemic effects can include:
    1. Congenital defects
    2. Macrosomia
    3. Intrauterine growth restriction
    4. Intrauterine fetal death
    5. Delayed lung maturity
    6. Neonatal hypoglycemia
    7. Neonatal hyperbilirubinemia
Assessment Findings
  1. Associated findings include a poor obstetric history, including spontaneous abortions, unexplained stillbirth, unexplained hydramnios, premature birth, low birth weight or birth weight exceeding 4,000 g (8lb, 13 oz), and birth of a newborn with congenital anomalies.
  2. Common clinical manifestations include:
    • Glycosuria on two successive office visits
    • Recurrent monilial vaginitis
    • Macrosomia of the fetus on ultrasound
    • Polyhydramnios
  3. Laboratory and diagnostic study findings.
    • Fasting blood sugar test will reveal elevated blood glucose levels.
    • A 50-g glucose screen (blood glucose level is measured 1 hour after client ingests a 50-g glucose drink) reveals elevated blood glucose levels. The normal plasma threshold is 135 to 140 mg/dL.
    • A 3- hour oral glucose tolerance test (performed if 50-g glucose screen results are abnormal) reveals elevated blood glucose levels. (Table 1)
    • The glycosylated hemoglobin (HbA 1c) test (measures glycemic control in the 4 to 8 weeks before the test is performed; performed on women with pre-existing diabetes) results reflect enzymatic bonding of glucose to hemoglobin A amino acids. This is a useful indicator of overall blood glucose control. The upper normal level of HbA1c is 6% of total hemoglobin.
    • Screens for fetal (and later, neonatal) complications, including:
      • Maternal serum alpha-fetoprotein level to assess risk for neural tube defects in newborn.
      • Ultrasonography to detect fetal structural anomalies, macrosomia, and hydramnios.
      • Nonstress test (as early as 30 weeks), contraction stress test, and biophysical profile because of risk of unexplained intrauterine fetal demise in the antepartum period.
      • Lung maturity studies (by amniocentesis) to determine lecithinsphingomyelin (L/S) ratio and to detect phosphatidylglycerol (PG); the adequacy of L/S and PG, predictor of the newborn’s ability to avoid respiratory distress