“Overcoming GDM Challenges: Ultimate Strategies for Confident Nursing Care”
Introduction
The full form of GDM is gestational diabetes mellitus. It is a metabolic disorder that is first detected during pregnancy. When a woman has never had diabetes before, but her blood sugar level becomes high during pregnancy, it is called GDM. It is a risk factor for the mother and the baby if it is not controlled in time. Therefore, understanding and dealing with the challenges of GDM is essential for every nurse and mother.
Defination
Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy.
Physiological Changes
Many hormonal and metabolic changes occur during pregnancy that increase the risk of GDM. Some of the physiological changes are:
Increased Insulin Resistance:
Placenta releases some hormones such as human placental lactogen that block the effect of insulin.
Increased Blood Glucose Level:
Increased insulin resistance prevents glucose from getting into cells and blood sugar level becomes high.
Increased Maternal Fat Storage:
The body stores fat so that the fetus can get energy – this also promotes insulin resistance.
Enhanced Gluconeogenesis:
Glucose production in the liver also increases.
GDM challenges develop due to these physiological changes.
Fasting and Postprandial Venous Plasma Sugar
Fasting and postprandial (post meal) sugar levels are very important to detect GDM.
Fasting Venous Plasma Sugar:
Normal value: < 95 mg/dl
If fasting sugar is more than 95 mg/dl then one should be alert.
Postprandial Venous Plasma Sugar:
1-hour post meal: < 140 mg/dl
2-hour post meal: < 120 mg/dl
If these levels are high then the risk of GDM challenges increases and management has to be started.
During pregnancy some hormones like estrogen, progesterone and human placental lactogen are released from the placenta which resist the action of insulin. This process is called diabetic state of pregnancy.
In normal women, pancreas balances this resistance by producing more insulin. But when the capacity of pancreas is low, blood sugar level becomes high and GDM develops.
Pregnancy Pathophysiology
During pregnancy some hormones like estrogen, progesterone and human placental lactogen are released from the placenta which resist the action of insulin. This process is called diabetic state of pregnancy.
In normal women, pancreas balances this resistance by producing more insulin. But when the capacity of pancreas is low, blood sugar level becomes high and GDM develops.
Effect of Diabetes on Pregnancy
If GDM Challenges are not managed timely, they can have very adverse effects on pregnancy:
Maternal Effects:
Hypertension and preeclampsia
Polyhydramnios (excessive amniotic fluid)
Increased chance of cesarean delivery
Urinary tract infections
Ketoacidosis (rare but dangerous)
Labor Complications:
prolonged labor
Obstructed labor due to big baby size
Fetal and Neonatal Hazards
Uncontrolled GDM also poses hazards to the baby:
🔴 Macrosomia: Baby’s weight exceeds 4 kg – delivery can be difficult.
🔴 Birth Injuries: Risk of shoulder dystocia or birth trauma increases.
🔴 Neonatal Hypoglycemia: Baby’s sugar level can drop suddenly after birth.
🔴 Prematurity: Chances of early delivery increase.
🔴 Respiratory Distress Syndrome (RDS): Breathing problems can occur due to immature lungs.
Diagnosis
Diagnosis
Timely diagnosis of GDM Challenges is important. The main test for diagnosis is:
✅ Oral Glucose Tolerance Test (OGTT)
Pregnant woman is given 75g glucose solution after fasting and sugar levels are checked after 1-hour and 2-hours.
According to WHO and ADA guidelines:
Fasting sugar > 95 mg/dl
1-hour post > 180 mg/dl
2-hour post > 153 mg/dl
If any of these values is high then GDM Challenges are confirmed.
Screening
Screening during pregnancy is very important so that GDM challenges can be detected timely.
Timing: All pregnant women should be screened between 24–28 weeks.
Methods:
Random Blood Sugar (RBS)
Fasting Blood Sugar (FBS)
OGTT
Early screening is recommended for high-risk mothers (family history, obesity).
Risk Factors
- Age > 25 years
- Family history of diabetes
- Obesity (BMI > 30)
- PCOS (Polycystic Ovary Syndrome)
- Previous big baby (> 4 kg)
- Hypertension
Treatment
The treatment of GDM mainly depends on blood sugar control:
✅ Lifestyle Modification:
Healthy diet and regular mild exercise can control sugar in many cases.
✅ Medical Therapy:
If sugar is not controlled by diet and exercise, the doctor prescribes insulin therapy.
Oral hypoglycemic agents such as Metformin can be used in limited quantity (with the advice of the doctor).
✅ Monitoring:
Regular monitoring of blood glucose is important.
Diet
Diet plan is the main part of GDM management.
- Low glycemic index foods
- High fiber diet (green vegetables, whole grains)
- Frequent small meals
- Avoid processed sugar, sweets and cold drinks
- Plenty of water intake
- Seeking help from a nutritionist or dietician
Puerperium Care
GDM challenges do not end even after delivery. Postpartum care is important:
✅ Keep monitoring sugar levels
✅ Breastfeeding controls mother’s sugar levels
✅ Tell mother about the risk of future Type 2 diabetes
✅ Make sure to do a glucose test 6–12 weeks postpartum
