Gestational Diabetes Mellitus
Gestational Diabetes Mellitus (GDM) — Nursing Notes & NMC 2026 Prep
A clear, exam-focused guide for nursing students — causes, screening, management and nursing care.
What is Gestational Diabetes Mellitus (GDM)?
Gestational Diabetes Mellitus (GDM) is glucose intolerance first recognized during pregnancy. It affects around 2%–5% of pregnant women and represents nearly 90% of pregnancy-related diabetes cases.
Definition
GDM is a metabolic disorder causing carbohydrate intolerance and variable hyperglycemia that begins or is first detected during pregnancy.
Pathophysiology
Placental and pregnancy hormones (HPL, estrogen, progesterone, prolactin, cortisol) decrease insulin effectiveness. If pancreatic beta cells cannot compensate by increasing insulin secretion, blood glucose rises and crosses the placenta, increasing fetal insulin and risk of macrosomia.
Risk Factors
- Previous GDM
- Family history of Type 2 diabetes
- Obesity (BMI ≥ 30 kg/m²)
- Age ≥ 35 years
- PCOS
- Previous macrosomic infant & high-risk ethnic groups
Signs & Symptoms
Many cases are asymptomatic. When present: polydipsia, polyuria, polyphagia, fatigue, blurred vision, and increased infections.
Screening & Diagnostic Criteria
All pregnant women should be screened. Standard tests:
- Glucose Challenge Test (GCT): 50g glucose; 1-hour blood sample.
- Oral Glucose Tolerance Test (OGTT): 100g glucose; fasting, 1-, 2-, and 3-hour samples.
| Time | Threshold (mg/dL) |
|---|---|
| Fasting | ≥95 |
| 1 hour | ≥180 |
| 2 hours | ≥155 |
| 3 hours | ≥140 |
Diagnosis: 2 or more values at/above thresholds.
Management
Goal: Maintain near-normal glucose to prevent complications.
- Diet: 6 small, high-fiber meals; avoid simple sugars; standard diabetic diet 2000–2500 kcal/day (do not drop below 1800 kcal if overweight).
- Exercise: 30 minutes moderate activity, ≥4×/week; avoid exercising where insulin injected.
- Medications: Insulin (first-line), Metformin, Glyburide.
- Monitoring: Fasting < 5.3 mmol/L; 1-hr < 7.8 mmol/L; 2-hr < 6.7 mmol/L. HbA1c every 4 weeks may guide control.
Intrapartum & Postpartum Care
Monitor maternal glucose every 1–2 hours during labour; aim for 80–110 mg/dL when on insulin infusion. After birth, insulin requirements fall rapidly. Encourage breastfeeding and perform a postpartum OGTT at 6 weeks. Long-term follow-up every 3 years for glucose intolerance.
Complications
Neonatal: Hypoglycemia, macrosomia, respiratory distress, birth trauma, polycythemia, hyperbilirubinemia.
Maternal: Preeclampsia, infections, ketoacidosis, higher C-section rates, later Type 2 DM, progression of retinopathy or nephropathy.
Nursing Responsibilities
- Educate mothers on self-monitoring and signs of hypo/hyperglycemia.
- Provide dietary counselling and reinforce exercise guidance.
- Monitor fetal well-being (NST, CTG, Doppler) and support postpartum follow-up.
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