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Gestational Diabetes
What is gestational diabetes?
Gestational diabetes, also known as gestational diabetes mellitus, GDM, or diabetes during pregnancy, is a type of
diabetes that only pregnant women get. If a woman gets diabetes when she is pregnant, but never had it before, then
she has gestational diabetes.
Normally, your stomach and intestines digest the carbohydrate in your food into a sugar called glucose. Glucose is
your body’s main source of energy. After digestion, the glucose moves into your blood to give your body energy.
To get the glucose out of your blood and into the cells of your body, your pancreas makes a hormone called insulin.
If you have diabetes, either your body doesn’t make enough insulin, or your cells can’t use it the way they should.
Instead, the glucose builds up in your blood, causing diabetes, or high blood sugar.
Gestational diabetes happens in about 5 percent of all pregnancies, or about 200,000 cases a year in the United
States.
How do I know if I have gestational diabetes?
Health care providers will test most women who have average risk for gestational diabetes when they are between
24-28 weeks pregnant.
If your risk is higher-than-average, your health care provider may test you earlier, possibly as soon as you know you
are pregnant.
There are two approaches to testing for gestational diabetes:
1. In the one-step approach, a woman will fast for 4 to 8 hours. Then a health care provider will measure her
blood sugar and will do so again 2 hours after she drinks a sugar drink. This type of test is called an oral glucose
tolerance test.
In the two-step approach, a health care provider measures a woman’s blood sugar 1 hour after drinking a
sugar drink. Women whose blood sugar is normal after 1 hour probably don’t have gestational diabetes. Women
whose blood sugar is high after 1 hour will then have an oral glucose tolerance test to see if they have gestational
diabetes.
Will gestational diabetes affect the baby?
Most women who have gestational diabetes give birth to healthy babies, especially when they control their blood
sugar, eat a healthy diet, exercise, and keep a healthy weight.
In some cases, though, gestational diabetes can affect the pregnancy and baby. Some potential risks include:
1. The baby’s body is larger than normal—called macrosomia. A large baby may need to be delivered by a
surgical procedure called cesarean section, instead of naturally through the vagina.
2. The baby’s blood sugar is too low—called hypoglycemia. Starting to breastfeed right away can help get
more glucose to the baby. The baby may also need to get glucose through a tube into his or her blood.
3. The baby’s skin turns yellowish and the whites of the eyes may change color—called jaundice. This
condition is easily treated and is not serious if treated.
4. The baby may have trouble breathing and need oxygen or other help—called Respiratory Distress
Syndrome.
5. The baby may have low mineral levels in the blood. This problem can causes muscle twitching or cramping,
but can be treated by giving the baby extra minerals
How is gestational diabetes treated?
Many women with gestational diabetes have healthy pregnancies and healthy babies because they follow a
treatment plan from their health care provider.
Each woman should have a specific plan designed just for her needs, but there are some general ways to stay
healthy with gestational diabetes:
Know your blood sugar and keep it under control – By testing how much sugar is in your blood, it is easier to
keep it in a healthy range. Women usually need to test a drop of their blood several times a day to find out their
blood sugar level.
Eat a healthy diet – Your health care provider can make a plan with the best diet for you. Usually controlling
carbohydrates is an important part of a healthy diet for women with gestational diabetes because carbohydrates
affect blood sugar.
Get regular, moderate physical activity – Exercise can help control blood sugar levels. Your health care
provider can tell you the best activities and right amount for you.
Keep a healthy weight – The amount of weight gain that is healthy for you will depend on how much you
weighed before pregnancy. It is important to track your both your overall weight gain and weekly rate of gain.
Keep daily records of your diet, physical activity, and glucose level – Women with gestational diabetes
should write down their blood sugar numbers, physical activity, and everything they eat and drink in a daily record
book. This can help track how well the treatment is working and what, if anything, needs to be changed.
Some women with gestational diabetes will also need to take insulin to help manage their diabetes. The extra insulin
can help lower their blood sugar level. Some women might also have to test their urine to see if they are getting
enough glucose.
What happens after the baby is born?
For most women, blood sugar levels go back to normal quickly after the baby is born. Six weeks after the baby is
born, you should have a blood test to check your blood sugar levels. The test also checks for your risk of getting
diabetes in the future.
If you know you want to get pregnant again, have a blood sugar test up to three months before becoming pregnant to
make sure your blood sugar level is normal.
Children whose mothers had gestational diabetes are at higher risk for obesity, abnormal glucose tolerance, and
diabetes.
Women who have had gestational diabetes and children whose mothers had gestational diabetes are at higher
lifetime risk for obesity and type 2 diabetes. It may be possible to prevent type 2 diabetes through lifestyle changes.
Talk to your health care provider about diabetes and increased risk from gestational diabetes.

Where can I get more information about gestational diabetes?

1. Am I At Risk for Gestational Diabetes?
2. Managing Gestational Diabetes: A Patient’s Guide to a Healthy Pregnancy

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 Teaching Plan L&D/OB-GYN - Unit Practice Manual Page 1 of 6 John Dempsey
Hospital-Department of Nursing The University of Connecticut Health Center
TEACHING PLAN FOR: Diabetes: Antepartum
PURPOSE: To delineate the educational needs and self care needs of a
patient with diabetes in pregnancy.
SUPPORTIVE DATA: During pregnancy, the body undergoes many changes. The
placenta produces hormones which cause a disruption in
insulin production, and an increase production of
glucose by the liver. As a result, the pregnant woman's
need for insulin increases. When there is not enough
insulin or the insulin is not used efficiently, high
blood sugar levels result, causing the diagnosis of
gestational diabetes. When the insulin dependent
diabetic is pregnant, her insulin needs must be
carefully monitored and managed throughout the
pregnancy as well.
DESIRED
TCOMES: 1. Patient will demonstrate and/or verbalize understanding of the self care
measures necessary for control of her diabetes during pregnancy.
2. In collaboration with the health care team, patient will maintain
diabetic control throughout the pregnancy in order
to facilitate optimal maternal/fetal outcome.
ASSOCIATED
STANDARDS: OB-GYN/L&D:
Diabetic Educational Training Packet
OB-GYN/L&D Unit Practice Manual:
Protocol for: Diabetic Antepartum: Care of the Patient
Diabetes (Insulin Dependent): Care of the Post-Partum
ASSESSMENT: 1. Assess patient's previous exposure to diabetes and present
knowledge of the disease.
2. Assess patient's ability to understand instructions, i.e. language
barrier, disabling mental/emotional capacity.
3. Assess patient's physical ability to perform self-care activities (i.e.
dietary selections, medication Teaching Plan L&D/OB-
GYN - Unit Practice Manual Page 2 of 6 John Dempsey
Hospital-Department of Nursing The University of
Connecticut Health Center TEACHING PLAN FOR:
Diabetes: Antepartum
preparation, self-injection, etc.).
GENERAL NURSING
CARE: 1. Distribute and review Diabetic Educational Training Packet.
2. Facilitate/coordinate interdisciplinary team plan (dietary consult,
Social Service, etc.).
3. Instruct patient in a quiet environment.
4. Instruct patient using lay terms.
5. Reinforce verbal instructions using pamphlets and handouts.
6. Have patient demonstrate activities taught and/or verbalize
understanding of instructions given (i.e., diet
exchanges, serum glucose monitoring, drawing-up and
injecting insulin, site rotation, etc.).
7. Implement appropriate prenatal teaching plan.
8. Provide anticipatory guidance for discharge needs and plan for
outpatient glucose monitoring.
PATIENT
EDUCATION: The nurse is responsible for identifying the educational needs
of the patient with diabetes, and teaching basic self-
care measures that assist in maintaining necessary
control of her diabetes. Include the following
information when educating the patient.
1. Discuss the inter-relationship between pregnancy and diabetes (see "What
is Gestational Diabetes" or "Pregnancy Changes" in
Educational Packet).
2. Discuss what effects hyper/hypo glycemia can have on the baby. Encourage
and support maternal-fetal attached by discussing
patient feelings and fears (see "Your Baby" in
Educational Packet).
3. The diagnosis of gestational diabetes and the monitoring of glucose
levels in the pregnant diabetic patient are
determined by routine blood test and various
diagnostic procedures. Using the Educational Packet,
explain the Teaching Plan L&D/OB-GYN - Unit Practice
Manual Page 3 of 6 John Dempsey Hospital-Department
of Nursing The University of Connecticut Health
Center TEACHING PLAN FOR: Diabetes: Antepartum
necessity for and procedures involved in the following:
a. Maternal Testing (refer to "Lab Tests" in Educational Packet):
1)1 hour Glucose test
2)3 hour Glucose test
3)Hemoglobin - AC
4)24 hour urine
5)Opthamology consult
6)EKG
7)Kidney function testing
b. Fetal Testing (refer to "Fetal Assessment" in Educational Packet):
1)Ultrasound
2)NST
3)Amniocentesis
4. Dietary Consult: Discuss balanced meal planning and reinforce its
importance in the control of blood sugar levels
while providing adequate nutrition for patient and
baby. See "Nutrition" in Diabetic Educational
Packet.
5. Discuss signs and symptoms of hypo/hyperglycemia and preventative
measures and treatments (see "Hypo/Hyper Glycemia
Sections" and "Glucagon" in Educational Packet).
6. Discuss and review with patient the various methods available for
glucose monitoring. Review with the patient her
current means of monitoring serum glucose levels.
See "Glucose Meters" in Diabetic Educational Packet.
7. Blood Glucose Levels: One of the most important goals in managing
diabetes while pregnant is to keep blood sugar
levels as close to normal range as possible. Review
with the patient:
a. Scheduled testing times
b. FBS - ideally should be 60-90
c. Sugars prior to meals - ideally 60-105
d. Sugars after meals - ideally less than 120 Teaching Plan L&D/OB-GYN -
Unit Practice Manual Page 4 of 6 John Dempsey
Hospital-Department of Nursing The University of
Connecticut Health Center TEACHING PLAN FOR:
Diabetes: Antepartum
8. discuss with the patient the effects of stress and/or exercise on
diabetic control. See Educational Packet.
9. Many insulin dependent diabetics develop problems with their feet.
Decreased circulation can result in decreased
feeling in the feet. It is important for the
diabetic to take proper care of the feet and toe
nails. Using the Educational Packet as a reference,
discuss with the patient:
a. Skin care
b. Proper cutting and maintenance of toe nails
c. Circulatory complications related to diabetes
10. Maternal Complications: The diabetic patient is at increased risk for
developing certain complications during pregnancy
due to her diabetes. Using the Educational Packet as
a reference, discuss the following:
a. Pregnancy Induced Hypertension (PIH)
b. Urinary Tract Infections (UTIs)
c. Polyhydramnios
d. Vaginitis
11. Insulin: When an insulin dependent diabetic patient becomes pregnant,
her insulin needs may require adjustment. Using the
Educational Packet as a reference, review the
following:
a. Insulin types
b. Drawing up and injecting insulin
c. Rotation of sites
d. Storage of insulin
e. Medical Alert Bracelet
f. Travel considerations Teaching Plan L&D/OB-GYN - Unit Practice Manual
Page 5 of 6 John Dempsey Hospital-Department of
Nursing The University of Connecticut Health
Center TEACHING PLAN FOR: Diabetes: Antepartum
12. Intrapartal Care: discuss with the patient pre-delivery instructions in
regard to her diabetes. Educate the patient
regarding amniocentesis and the possibility of
induction of labor. See "Intrapartal Care" in
Educational Packet.
13. Postpartum Care: For the gestational diabetic, glucose levels generally
return to normal after a delivery and diet
regulation is no longer needed. For the insulin
dependent diabetic, insulin may not be required for
the first 24-48 hours following delivery. The
patient's insulin requirement will then be adjusted
based upon the patient's needs. Using the
Educational Packet as a reference, include the
following, when instructing the post-partum patient:
a. Contraception
b. Preconceptual counselling
c. Sexuality
d. Breastfeeding considerations
REPORTABLE
CONDITIONS: 1. Language barrier or inability to comprehend instruction.
2. Patient physically unable to perform tasks.
3. Blood glucose levels which exceed MD parameters.
4. Noncompliance with dietary regimen and or insulin doses.
5. Hyper/hypoglycemic symptomatology.
6. Patient unwilling to report and/or perform directions given.
DOCUMENTATION: 1. Initiate Standard Care Plan and Database on Admission.
2. Initiate Diabetic Educational Needs Flowsheet.
3. Document patient response to instructions given as per Documentation
Standards, Department of Nursing. Teaching Plan
L&D/OB-GYN - Unit Practice Manual Page 6 of 6 John
Dempsey Hospital-Department of Nursing The
University of Connecticut Health Center TEACHING
PLAN FOR: Diabetes: Antepartum
APPROVAL: Nursing Standards Committee
CREDENTIALS: RN
EFFECTIVE DATE: 3/91