Gestational Diabetes Mellitus: A Case Study

The general health and well-being of a pregnant woman and her baby is always the priority during the entire journey of pregnancy. When a pregnant woman is diagnosed to have gestational diabetes mellitus (GDM), this may implicate short or long term complications to the woman and the fetus.
This lesson aims to provide basic education to expecting mothers attending the antenatal class about Gestational Diabetes Mellitus (GDM) and its management.
The objectives of the antenatal class is to (a) briefly discuss what is GDM and its cause; (b) know its common risk factors and complications to the pregnant mother and the baby, and how it is diagnosed; and (c) provide information to expecting mothers about GDM management during pregnancy and after

the delivery of the baby.
Gestational diabetes mellitus (GDM) is a disease that affects most of the pregnant women globally which can result in fetal and maternal deaths if not managed properly. As defined by Mpondo, Ernest, and Dee (2015), GDM is “any degree of glucose intolerance with onset or first recognition during pregnancy”. This happens when the hormones made by the placenta cause glucose build-up in the blood however the woman's body cannot produce enough insulin to maintain the sugar levels (Diabetes Queensland, 2017). When GDM is detected during the first 12 weeks of pregnancy, it is probable that it has developed beforehand but was only found when screened during pregnancy (Diabetes NSW, 2017).
Globally, 90% of pregnant women experience complications because of GDM. 40-60% of these pregnant women have the likelihood to develop diabetes mellitus (DM) 5 to 10 years after their pregnancies (Mpondo, Ernest, & Dee 2015). In Australia, about 8-10% of women has Gestational Diabetes Mellitus (Nankervis et al., 2014) which involved pregnant women who had unknown Type 2 diabetes mellitus and an uncommon onset of Type 1 diabetes mellitus (Conn & Nankervis, 2013).
While awareness of the disease may be important, it is also notable to know who have greater chances of developing gestational diabetes mellitus. As cited in Diabetes NSW (2017), elements which may influence women in acquiring GDM during pregnancy are obesity and being overweight, family history of type 2 diabetes mellitus, ethnicity (including Aboriginal or Torres Strait Islanders, Indian, Asian, Middle Eastern or Polynesian), GDM in previous pregnancy, and women over 30 years old. Templeton and Pieris-Caldwell (2008) added that mothers who has GDM are at risk of having hypertension and pre-term birth related to high or low fetal birth-weight which will result to an induction of labour or performing caesarean section. This leads to a longer hospital stay postnatally. Diabetes Australia (2015) has clearly mentioned that a large for gestational age baby (fetal macrosomia) from a gestational diabetic mother is at higher risk for forceps delivery that can possibly cause trauma to both mother and the baby. The newborn baby will also need to stay in the special care nursery to monitor its blood glucose level. The National Institute of Diabetes and Digestive and Kidney Diseases (2014) has further enumerated complications for the newborn babies such as respiratory distress syndrome and higher possibility of infant death before or after its delivery.
Because of the prevalence of GDM in the pregnant women population in Australia, it is now recommended that all women who have previous GDM cases and those who have several risk factors should undergo a 75g Oral Glucose Tolerance Test (OGTT) at 24-28 weeks gestation (Conn & Nankervis, 2013). Although blood sugar level targets differ between health practitioners and healthcare facilities around Australia (Nankervis et al., 2014), Australasian Diabetes in Pregnancy Society (ADIPS) has suggested the following blood glucose level targets for women with GDM: before eating breakfast a BGL of s immune system and it promotes early bonding between the mother and the baby (Diabetes Australia, 2015). Conn and Nankervis (2013) also pointed out that there was an evidence proposes breastfeeding as weight management for both mother and baby who are likely to become overweight.
Generally, gestational diabetes will be resolved soon after the delivery of the baby. The woman should discontinue any insulin therapy or oral hypoglycaemic agents taken while pregnant (Diabetes NSW, 2017). The woman is then advised by a clinician to do a 75g Oral Glucose Tolerance Test 6-12 weeks after delivery to check whether she still has diabetes, (Nankervis et al., 2014). Some women, though, will continue to have diabetes after the test which is commonly Type 2 diabetes mellitus. These women will need to continue following a strict healthy diet plan and exercise, and take medications as needed (The National Institute of Diabetes and Digestive and Kidney Diseases, 2014). Women who had GDM have approximately 50% chance of developing type 2 diabetes mellitus, Diabetes NSW (2017) recommended a yearly fasting blood test.
Diabetes in pregnancy causes burden to the pregnant woman and her growing fetus. Therefore a well-balanced diet and exercise is important to maintain physical fitness and healthy well-being. It is also important for the healthcare practitioners, such as the midwives, to offer an opportunity to provide safe and effective interventions to prevent or reduce risk and complications for both the mother and her baby.

References
Conn, J., & Nankervis, A. (2013, August). Gestational diabetes mellitus: Negotiating the confusion. Growing epidemics, 42(8), 528-531. http://www.racgp.org.au/afp/2013/august/gestational- diabetes-mellitus/
Diabetes Australia.

(2015). Gestational Diabetes: Caring for yourself and your baby. Retrieved from https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/8f48dbe1-a2b3-4bb8-8822-0aa6954e8aec.pdf
Diabetes NSW. (2017). Gestational diabetes. Retrieved from http://diabetesnsw.com.au/what-is-diabetes/gestational-diabetes/
Diabetes Queensland. (2017). Gestational Diabetes. Retrieved from http://www.diabetesqld.org.au/managing-diabetes/gestational-diabetes.aspx
Mpondo, B. C., Ernest, A., & Dee, H. E. (2015). Gestational diabetes mellitus: challenges in diagnosis and management. Journal of Diabetes & Metabolic Disorders, 14(1). doi:10.1186/s40200-015-0169-7
Nankervis et al. (2014). ADIPS Consensus Guidelines for the Testing and Diagnosis of Gestational Diabetes Mellitus in Australia. Retrieved from http://adips.org/downloads/2014ADIPSGDMGuidelinesV18.11.2014_000.pdf
Templeton, M., & Pieris-Caldwell. (2008). Gestational diabetes mellitus in Australia, 2005–06. Diabetes series no. 10. Cat. no. CVD 44. Canberra: AIHW.
The National Institute of Diabetes and Digestive and Kidney Diseases. (2014). Gestational Diabetes. Retrieved from https://www.niddk.nih.gov/health-

information/diabetes/overview/what-is-diabetes/gestational