Diabetes Mellitus Prepregnancy/Gestational
This disorder of carbohydrate metabolism of variable severity may be preexisting (pregestational insulin-
dependent diabetes mellitus [IDDM] or non–insulin-dependent diabetes mellitus [NIDDM]), or may develop during
pregnancy (gestational diabetes mellitus [GDM]).
(This plan of care is to be used in conjunction with the Trimesters and the High-Risk Pregnancy.)
CLIENT ASSESSMENT DATA BASE
Pedal pulse and capillary refill of extremities may be diminished or slowed (with diabetes of long duration).
Edema, elevated BP (PIH).
May have history of pyelonephritis, recurrent UTI, nephropathy
Nausea and vomiting.
Obesity; excessive or inadequate weight gain (client with GDM is usually obese; client with IDDM is not usually obese
May report episodes of hypoglycemia, glycosuria.
Skin integrity/sensation of arms, thighs, buttocks, and abdomen may be altered from frequent injections of insulin.
Visual impairment/retinopathy may be present.
History of symptoms of infection and/or positive cultures for infection, especially urinary or vaginal.
Fundal height may be higher or lower than normal for gestational age (hydramnios, inappropriate fetal growth).
History of large for gestational age (LGA) neonate, hydramnios, congenital anomalies, unexplained stillbirth.
Socioeconomic concerns/factors can increase risk of complications.
Inadequate or lack of committed support system (may adversely affect diabetic control).
Client’s own birth weight may have been 9 lb or more.
May report recent problems/change in stability of diabetic control.
Family history of diabetes, GDM, PIH, infertility problem; LGA infant, history of neonatal death(s), stillbirth,
congenital anomalies, spontaneous abortion, hydramnios, macrosomia (greater than 4000 g or 9 lb at birth).
Glucose Tolerance Test (GTT):
Elevated above 140 mg/dL at 24–28 weeks’ gestation. Clients with specific risk
factors are screened at first prenatal visit. (If screening result is positive,
3-hr glucose challenge or oral glucose tolerance test [OGTT] test done to make diagnosis.)
Glycosylated Hemoglobin (HbA
Reveals glucose control over previous 4–8 wk. Levels greater than 8.5%,
especially before pregnancy, puts the fetus at risk for congenital anomalies.