Patient education leaflet for gestational diabetes management in pregnancy

¶ … staff nurse in Obstetrics and Gynecology ward who works in a hospital in Saudi Arabia. In my area of practice, there are no patient educators role. Every year, a great number of antenatal patients come with Gestational Diabetes Mellitus, also referred to as GDM and therefore I feel that there is a need to educate the patients about this condition and its management so that complications of the disease cannot does not put the pregnancy, the mother and fetus at risk. I decided to do an educational resource about how to manage gestational diabetes effectively and safely. The purpose of this educational resource is the devision of a leaflet, in English and Arabic. Since it is the obligation of the nurses to make sure that the patients understand the complications of the diseases, the consequences of GDM can be explained to the relatives of the patients if there is a language problem.

The importance of Gestational Diabetes as a medical condition cannot be underestimated as the complications of this condition can have serious consequences on the health of the mother and the baby during the pregnancy and even after the pregnancy has ended. Many women develop an increased blood sugar level around the 24th week of pregnancy (Doheny 2009). A woman is labeled to have Gestational Diabetes when she is known non-diabetic but develops diabetes during pregnancy. Having been diagnosed with Gestational Diabetes does not mean that woman had diabetes before she conceived; neither does it mean that she will have diabetes after she has given birth. However, it does mean that the woman who has developed gestational diabetes is carrying a high risk pregnancy and therefore she needs to take care of herself and act according to the advice of the doctor.

The purpose of this essay is to explore ways through which gestational diabetes can be managed safely as well as effectively. The primary focus of the educational resource is to make sure that the nurses play their role in educating the pregnant women about gestational diabetes mellitus since there are is no department of patient guidance in my area of practice. A treatment plan that increases the patients and nursing satisfaction is the one that will prove to be the most effective one. By adopting such a management plan, improvement of quality nursing care and patient life is sought. In this essay, I will also discuss how the increase in the level of nursing autonomy leads to improved health care services, specifically pertaining to the management of gestational diabetes.

In addition, I want to expand the nurses' role and advance nursing practice as a patient educator or clinical nurse specialist in GDM. It is also important to note here that the objectives of this essay do not only include the education of the patients but of the nurses as well. It is important to make the nurses realize that they have to take up the role of the patient educator.

Theoretical Framework for the Leaflet

There are a number of theories that can be employed with respect to discovering an effective way of preventing, diagnosing and treating GDM. One of the theories that can be used in this case is Orem's General Nursing Theory. The analysis that is made according to this theory lays emphasis on the fact that effective treatment of GDM lies in identification of self-care deficiencies and education of the pregnant women. According to a research that was conducted based on this theory, self-care deficiencies were associated with physical activities, eating habits, sleep and rest, and social and personal interactions. Moreover, Orem's theory also suggests that nurses should evaluate and assess the self-care capacity of the patients and then propose actions according to that, such as the involvement of the family and arrangement of group activities in health care services (Enferm 2008). Therefore, the aforementioned are the points that need to be there in the educational resource, so that the patients can alter their habits and prevent complications.

Gestational diabetes does not normally have any symptoms. This is the reason why all pregnant women are required to undergo a screening test for blood glucose levels between 24 and 28 weeks of pregnancy. However, if a woman is identified as a high risk patient for diabetes, then it is the role of nurses to advice a screening test on the first prenatal visit. The women are then asked to repeat this test again between 24 and 28 weeks even if the initial result did not reveal diabetes. (Blatt et. al 2011)

However, blood glucose test (fasting or random) is not a diagnostic test. A positive glucose screening test does not imply that a woman has gestational diabetes. She will have to undertake the diagnostic test for this condition is that the glucose tolerance test, also referred to as GTT (Blatt et. al 2011).

According to the American Diabetes Association, doctors and nurses should screen the women with the following factors on their first prenatal visit.

1. If a woman is obese with a body mass index more than 30

2. If a woman has had gestational diabetes in her previous pregnancy

3. If the urine test reveals glucose

4. If a woman has a family history for diabetes mellitus

Nurses should also be concerned about the pregnancy of some women who have the potential for developing gestational diabetes. Apart from the risk factors mentioned above, these women are likely to have the following risk factors as well:

1. If she has given birth to a macrosomic (big) baby. The cutoff value is 8-9 pounds

2. If she has an unexplained stillbirth

3. If her previous baby was born with a birth defect

4. If she has hypertension

5. If the age of the woman is more than 35 years

According to a study that was issued by Obstetrics and Gynecology and published in the year 2010, a relationship was also found between increased weight gain during pregnancy and the development of gestational diabetes. Researchers discovered that women who had excessive weight gain during the first trimester of pregnancy were at the highest risk of developing gestational diabetes. Moreover, this condition has also been found to be more common in nonwhite women.

The aim of a treatment plan for gestational diabetes is to keep the blood sugar levels within the normal. The treatment plan for this condition will always include the scheduled physical activity and special meal plans. The American Diabetes Association has given a list of targets for the women who have developed gestational diabetes during the second or third trimester of pregnancy.

1. Preparadial (before a meal): less than or equal to 95 mg/dl

2. Postprandial (1 hour after meal): less than or equal to 140 mg/dl

3. Postprandial (2 hours after meal): less than or equal to 120 mg/dl

Nurses, and other health care givers, have an important role to play when it comes to the treatment of women with gestational diabetes. These women also need to be reassured that it is not a dangerous condition unless they are taking care of themselves. Since most of these women have to undergo a cesarean section to give birth, the level of anxiety is also raised. Therefore, it is the role of the nurses to counsel these women that if they keep their sugar levels within limits, the c-section might not even be required (American College of Obstetricians and Gynecologists 2001).

Literature Review

As explained earlier, gestational diabetes is a medical condition that needs to be treated so that the complications can be prevented in the fetus as well as in the mother. In order for us to make a treatment plan, it is important to study the complications of the condition pertaining to the fetus as well as the pregnancy. Apart from that, the discussion of an effective treatment plan that would keep the blood glucose levels within the target limits shall also be reviewed (Fradkin 2012).

The condition can be effectively treated if the women have all the information that they need to know about this disease. A study was carried out with 12 pregnant females that were being cared at hypertension and diabetes reference institution in Fortaleza, Ceara, Brazil, in April and May, 2007. The data was collected by conducting interviews. The results were suggestive of the fact that GDM can be effectively treated and its complications can be prevented if the patients are aware of the disease.

Fetus

The babies of the pregnant women with gestational diabetes are normally very big. The cutoff value that is used to label a baby as macrosomic (big in size) is different at different places. However, the range lies between 8 to 9 pounds. The big size of the baby can result in a number of traumatic injuries during vaginal delivery. The most common complication is known as shoulder dystocia . The reason why the babies of diabetic mothers are so big is that when the extra glucose from the blood of the mother crosses the placenta, the pancreas of the baby is stimulated to produce extra amounts insulin that result in the increased growth of the baby. The babies are also prone to sustain more injuries during a cesarean delivery as compared to the babies of normal size (Sermer et. al 1995).

Women who develop gestational diabetes are prone to go into early labor. Also, some doctors would recommend an early delivery because of the increasing size of the baby, which later causes problems during delivery (Crowther et. al, 2005). Since the lungs of the babies are not developed properly, the babies can experience an intense breathing condition that is known as respiratory distress syndrome. It should be noted here that babies born to diabetic mothers may experience this syndrome even if they are born on the due date (Fradkin 2012).

Because of the increased insulin production, sometimes babies of the diabetic mothers will develop hypoglycemia after birth. If the hypoglycemia is high enough, it can also provoke seizures in baby. In order to treat this hypoglycemia occurring shortly after birth, the baby is infused with intravenous glucose or is fed promptly (Catalano et. al 2003).

Jaundice is a physiological phenomenon is some babies, but this condition can be prolonged in babies that are born to diabetic mothers. Jaundice is basically the yellowish discoloration of the sclera of the eyes and the skin. It occurs in babies because their liver has not matured to the point where it would metabolize the yellow substance known as bilirubin. This substance is formed from the breakdown of the dead and damaged red blood cells. Even though, jaundice resolves automatically, but it should be monitored carefully in the babies since it can cause brain damage (Fradkin 2012).

Babies who are born to mothers who had gestational diabetes are placed at a higher risk of developing type 2 diabetes mellitus, secondary to obesity later in life. It should also be noted here that untreated gestational diabetes can lead to birth defects in the babies and also in the unexplained death of the baby during pregnancy or even shortly after (L and Im et al., 2008, pp. 374 -- 381).

Mother

Apart from many complications that are suffered by the fetus because of gestational diabetes, the mother also suffers from some serious consequences if she does not manage her diabetes and does not control her sugar levels. The women that develop gestational diabetes are at a higher risk of developing type 2 diabetes and hypertension even after the pregnancy has ended. These women are also placed at a higher risk of developing preeclampsia and eclampsia (American Diabetes Association 2013). The aforementioned are considered to be two serious complications of pregnancy, while latter is a medical emergency. These two complications cause high blood pressure and some other symptoms that prove to be threatening for the lives of the baby and the mother.

Moreover, if a woman develops gestational diabetes in one pregnancy, chances are high that she would develop it again during her next pregnancy. As mentioned earlier, these women also develop type 2 diabetes as they grow older. However, it should be noted here that if the nurses counsel the patients to return to the ideal body weight after delivery of the baby, there are less chances to develop type 2 diabetes mellitus (Reece et. al 2008).

Completion of the Educational Resource and its use in Practice

There is some information that is required to be published on the leaflet for the benefit of the women with gestational diabetes. The primary aim is to make them aware of the complications of this condition. Considering the theories and our knowledge of this disease, the leaflet will also contain a treatment plan that can be explained to the individuals personally.

Conclusion

Since the education of the patients about their diseases and its complications is just as important as the treatment, it is mandatory for every department to have a patient educator. There is no such facility available in my area of practice and therefore the production of an education resource (leaflet in this case) was extremely important and therefore a research was carried out about gestational diabetes mellitus, its complications and management plan. This educational resource aims to provide the patients with the important details that they need to know about their disease and also to advance the role of nurses in the practice area.

Throughout the discussion, the role of nurses has been emphasized. It is important for the nurses to be autonomous and competent in their work so that they can make their due contribution towards the effective management of gestational diabetes. Nurses have the potential to improve the quality of health of the patients. Therefore, the significance of nurses in the field of health care cannot be taken for granted.