Gestational Diabetes, When women get pregnant

Gestational Diabetes

When women get pregnant for the first time, they can easily develop gestational diabetes. According to research, in America, in a population of 100 women who are pregnant, around three to eight of them are bound to have gestational diabetes. When women are pregnant, they are affected by factors such as weight gain and ever changing hormones. These changes prevent the insulin hormone to function as it is meant. According to the American Diabetes Association, the number of gestational diabetes cases is as high as 200,000. Unfortunately, this figure is escalating at an extremely high rate, and women ought to know how to prevent it. When a woman has gestational diabetes, it means that their insulin and hyperglycemia does not function well. This is due to problems concerning adaptation by beta cells and the latter can also become dysfunctional. Women who have gestational diabetes can have high blood pressure when giving birth. Moreover, the chances of them having caesarian sections are extremely high. Some of the factors, which make women likely to have gestational diabetes include; family history, obesity, as well as age. There is a need to know more about this deadly condition and how it manifests itself.

This paper seeks to give a critical analysis on gestational diabetes, concerning how it manifests itself in various instances. Furthermore, it seeks to discuss it how gestational diabetes affects nursing practices.

Annotated Bibliography

Ross, M. G. & Ervin, M. G. &Novak, D. (2007). Chapter 2 fetal physiology. In S. Gabbe, & J. Niebyl, & J. Simpson (Eds.), Obstetrics: Normal and problem pregnancies (pp. 26-33). Philadelphia, PA: Churchill Livingstone Elsevier.

According to this book, women giving birth for the first time are bound to develop gestational diabetes. The placenta plays an extremely vital role when a child is being formed in the mother’s womb. It has several functions such as providing the fetus with water, oxygen and even hormones. The latter is needed for the formation of healthy babies. Glucose is also vital, and it is needed for growth of the woman’s fetus. According to research done by the authors of the book, maternal glucose is needed by the placenta. The glucose that exists in the womb of the mother is at 70% and is used for various vital functions. In order for glucose to reach the fetus, it is transported by the GLUT 1. Thus, when a woman has gestational diabetes, the GLUT 1 does not function as it ought. In turn, it leads to extremely high levels of maternal glucose in the fetus. Insulin is then produced for the purpose of growth of the baby in the fetus. Moreover, levels of blood sugar in the mother are increased, and this has serious repercussions. The book seeks to show how pregnant women develop gestational diabetes depending on their neonates found in their system.

Barta, E. & Drugan, A. (2010). Glucose transport from mother to fetus— A theoretical study. Journal of Theoretical Biology, 263, 295-302. doi: 10.1016/j.jtbi.2009.12.010

According to the journal article by Drugan and Barta, they sort to find out how the fetus is provided with glucose. They found out that the GLUT 1 is responsible, and this is through a model that used mathematical equations. They believe that glucose is extremely vital in formation of the fetus, as well as that of the placenta. Without the presence of the GLUT 1, maternal glucose would not be transported. There are certain factors, which enable the maternal glucose to be transported. The most essential one is a concentration gradient that is used in the process of diffusion. This means that the fetus and the mother are well connected through the placenta. Their model provided crucial information regarding why the second trimester is the one when the pregnant woman is most vulnerable. They believe that their research needs further improvement especially in matters concerning insulin and hormones.

The HAPO Study Cooperative Research Group. (2008). Hyperglycemia and adverse pregnancy outcomes. The New England Journal of Medicine, 358(19), 1991-2002.

The article focuses on research by the HAPO Study Cooperative Research. It meant to find out the dangers, which are related with varying levels of maternal glucose intolerance. Their study was conducted on 25, 505 pregnant women. They used various mathematical methods in order to arrive at their conclusions. They made use of odd ratios and frequency, so as to determine levels of maternal glucose. When the levels of maternal glucose were high, the fetus had high chances of developing with defects. The standards deviation helped in knowing, which births were likely to be harmed. In some cases, those who had 1.07 to 1.09 SD levels were often admitted into intensive neonatal care. Furthermore, the women were likely to undergo cesarean sections. The authors want more research to be done in order to find out how hyperglycemia can be treated as well as diagnosed.

Lawlor, D. A. & Fraser, A. & Lindsay, R.S.& Ness, A.& Dabelea, D.& Catalano, P. &Nelson, S. M. (2010). Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: Findings from a prospective pregnancy cohort. Diabetologia, 53, 89-97. doi: 10.1007/s00125-009-1560-z

Research was conducted by the various authors in order to find the relation, which exists between glycosuria and gestational diabetes during pregnancy. The variables used in the study were BMI of future offspring, macrosomia, as well as birth weight. The ages of those being measured were 9 to 11 years, through using their fat mass and waist circumference. The results show that women who had diabetes risk having their infants develop macrosomia. They also had high chances of being overweight, among others. The measurements used included the use of standard deviation. It is believed that the sample size used in the study was not enough. In the future, they recommend that the size be increased. According to their research, nursing practitioners should be able to diagnose gestational diabetes early enough. In turn, the infants will be saved from suffering in the future.

Hedderson, M. M. & Gunderson, E. P.& Ferrara, A. (2010). Gestational weight gain and risk of gestational diabetes mellitus. Obstetrics and Gynecology, 115(3), 597-604.

The authors of this journal article sort to carry out a study to find out about how gestational diabetes is related to weight gain. They sort to found this out through the use of the frequency method. Furthermore, the test included the use of a glucose tolerance test being administered to the pregnant women. According to their results, the chances of developing gestational diabetes are 2.3, when pregnant women gain weight. It is extremely dangerous as they have around an 80% chance of acquiring it and mostly in the first semester. There is a P<0.5 chance that even the pregnant woman’s BMI will increase. The study also found out that those likely to develop gestational diabetes were women not from the white race and those who were overweight. The authors suggest that there is a need to find out more about their study. In turn, clinical practitioners should inform pregnant women on the dangers of gaining unhealthy weight. They risk suffering from gestational diabetes as well as harming their unborn child.

Retnakaran, R., Qi, Y., Sermer, M., Connelly, P. W., Hanley, A. J. G., &amp; Zinman, B. (2010). Beta-cell function declines within the first year postpartum in women with recent glucose intolerance in pregnancy. Diabetes Care, 33(8), 1798-1804. doi: 10.2337/dc10-0351

The study carried out by the various authors sort to find out about the gestational diabetic risk that pregnant women had. This is when they were subjected to postpartum conditions in their first years. Also, the study measured metabolic changes, which pregnant women undergo, due to high levels of maternal glucose. The results they found out were that P<0.0005 is the postpartum, when there is a decrease in the levels of beta cell and insulin sensitivity. These were measured after a period of three months. The figure kept on increasing as the months also did the same, in what is known as a dysglycemic state. Furthermore, depending on the extent of gestational dysglycemia, insulin sensitivity and beta cell dysfunction occurred. The pregnant woman also risks developing type 2 diabetes if the postpartum period increases. According to the researchers, during postpartum and pregnancy women can easily be victims of type two diabetes. Thus, clinicians should make women more aware about gestational diabetes.

Landon, M. B. & Spong, C. Y. & Thom, E.& Carpenter, M. W.& Ramin, S. M.& Casey, B.& Anderson, G. B. (2009). A multicenter, randomized trial of treatment for mild gestational diabetes. The New England Journal of Medicine, 361(14), 1339-1348.

The researchers of this study used 1889 pregnant women as their subjects. There were certain conditions, which the women had to meet before they could take part. The study sort to found out if obstetrical conditions and perinatal conditions could be reduced by treatment administered for gestational diabetes. This means that there had to be a control and treatment group. The latter was administered with insulin, diet therapy, as well as having to go for counseling sessions. According to the results, those who received early treatment for gestational diabetes were likely to have healthy futures. An example is when the chances of having cesarean deliveries were reduced by 33.8%. The researchers want to ensure that clinicians find ways they can reduce the complications brought about by gestational diabetes.

Rowan, J. A. & Hague, W. M. & Gao, W. & Battin, M. R. & Moore, M. P. (2008). Metformin versus insulin for the treatment of gestational diabetes. The New England Journal of Medicine, 358(19), 2003-2015.

The researchers of this study sort to find out if gestational diabetes treatment is best given by insulin or Metformin. Furthermore, they wanted to found out if women treated with insulin, rather than Metformin, would have infants with disorders. The researchers used three different study populations, who were administered various treatments. It seems that the there is no difference in treatments, which are insulin or Metformin based. This means that complications that are neonatal were not likely to occur. The Metformin group is the one, which has a low frequency of neonatal hypoglycemia. They found out that the latter had a frequency level of P=0.008. Thus, it is better for clinicians to treat pregnant women who have gestational diabetes with insulin. The researchers are pensive about the results, as they believe that other crucial factors were not included. They still believe that metformin should be used in gestational diabetes treatment. They warn that caution must be taken when using metformin.

Work Cited

Barta, E. & Drugan, A. (2010). Glucose transport from mother to fetus— A theoretical study. Journal of Theoretical Biology, 263, 295-302. doi: 10.1016/j.jtbi.2009.12.010

Landon, M. B. & Spong, C. Y. & Thom, E.& Carpenter, M. W.& Ramin, S. M.& Casey, B.& Anderson, G. B. (2009). A multicenter, randomized trial of treatment for mild gestational diabetes. The New England Journal of Medicine, 361(14), 1339-1348.

Lawlor, D. A. & Fraser, A. & Lindsay, R.S.& Ness, A.& Dabelea, D.& Catalano, P. &Nelson, S. M. (2010). Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: Findings from a prospective pregnancy cohort. Diabetologia, 53, 89-97. doi: 10.1007/s00125-009-1560-z

Hedderson, M. M. & Gunderson, E. P.& Ferrara, A. (2010). Gestational weight gain and risk of gestational diabetes mellitus. Obstetrics and Gynecology, 115(3), 597-604Retnakaran, R., Qi, Y., Sermer, M., Connelly, P. W., Hanley, A. J. G., &amp; Zinman, B. (2010). Beta-cell function declines within the first year postpartum in women with recent glucose intolerance in pregnancy. Diabetes Care, 33(8), 1798-1804. doi: 10.2337/dc10-0351

Retnakaran, R., Qi, Y., Sermer, M., Connelly, P. W., Hanley, A. J. G., &amp; Zinman, B. (2010). Beta-cell function declines within the first year postpartum in women with recent glucose intolerance in pregnancy. Diabetes Care, 33(8), 1798-1804. doi: 10.2337/dc10-0351

Ross, M. G. & Ervin, M. G. &Novak, D. (2007). Chapter 2 fetal physiology. In S. Gabbe, & J. Niebyl, &amp; J. Simpson (Eds.), Obstetrics: Normal and problem pregnancies (pp. 26-33). Philadelphia, PA: Churchill Livingstone Elsevier.

Rowan, J. A. & Hague, W. M. & Gao, W. & Battin, M. R. & Moore, M. P. (2008). Metformin versus insulin for the treatment of gestational diabetes. The New England Journal of Medicine, 358(19), 2003-2015.

The HAPO Study Cooperative Research Group. (2008). Hyperglycemia and adverse pregnancy outcomes. The New England Journal of Medicine, 358(19), 1991-2002.