Gestational diabetes mellitus (GDM) is widely debated as one of the controversial and less-researched medical conditions. The prevalence of GDM is at an all-time high of 15%, which is expected to grow significantly due to the increasing amount of obese women of reproductive age (Mensah et al., 2019). The reason for such high numbers is the trend in urbanization in upper-middle-income countries, which has resulted in increased caloric supply (in general) and decreased employment of women in the agricultural industry (in particular). GDM has a negative impact on the economy and is associated with various pregnancy complications that put mothers and their unborn children at risk (Chiefari et al., 2017). However, the topic of GDM remains highly controversial since there are no uniform prevention strategies and care management plans. The latest studies (Carolan-Olah, 2016; Mensah et al., 2019) report that the future of GDM treatment lies in preventative care, which is why registered nurses (RN) become vital in the management of patient education and the supervision of healthcare interventions.
Overview of Gestational Diabetes Mellitus
There is a need to define the symptoms, health effects, and treatment options for GDM as the most common metabolic disorder of pregnancy. GDM is a type of glucose intolerance that develops in the second and third trimesters and results in numerous maternal complications. Mensah et al. (2019) identify “hypertension, pre‐eclampsia, cesarean section, infection and polyhydramnios” as the most common complications (p. 79). GDM is categorized as a condition “related to fetal morbidity in terms of macrosomia, birth trauma, hypoglycaemia, hypocalcaemia, hypomagnesemia, hyperbilirubinemia, respiratory distress syndrome and polycythemia” (Mensah et al., 2019, p. 79). In addition, women with GDM are at a higher risk of developing type 2 diabetes and a range of cardiovascular conditions after pregnancy (Chiefari et al., 2017). At the moment, health professionals focus on early screening and diagnosis based on the known risk factors. Once diagnosed, women are subject to lifestyle modifications and routine screening (Mensah et al., 2019). However, the most severe cases of GDM are treated by means of metformin, glyburide, and insulin (Mensah et al., 2019). The increasing incidence and resulting short- and long-term health effects of GDM emphasize the importance of generating effective treatment strategies.
Relevance to Nursing
Nurses play an important role in the treatment of GDM. Since there is significant evidence supporting the implementation of health interventions and various forms of patient education (Carolan-Olah, 2016; Mensah et al., 2019), nursing professionals take on numerous responsibilities in planning and managing these initiatives. Women at high risk of developing GDM require medical advice on diet, physical exercise, and weight control, which often comes from primary care nurses. In addition, nursing practitioners are tasked with providing these women with all the necessary information regarding smoking and alcohol cessation, as well as the withdrawal of certain medications. Apart from behavioral interventions and educational programs, nurses are also involved in blood glucose tests and selective screening (Mensah et al., 2019). Both general physicians and RNs assist women diagnosed with GDM by monitoring and interpreting their blood glucose levels, and treating numerous possible health complications such as hypoglycemia and hypomagnesemia (Mensah et al., 2019). Therefore, it is crucial for nurses to have a strong theoretical framework in order to utilize the knowledge in practice.
Patient Education and Nursing Interventions
Preventative care is the primary focus of the latest academic research regarding GDM and possible complications associated with the disease, which puts nurses at the forefront of delivering vital health information to patients during pregnancy and postpartum. Since GDM is the most common metabolic condition experienced by pregnant women (Chiefari et al., 2017), nurses are obligated to consult patients and their families about the possibility of developing such a condition. In addition, high-risk individuals often require general physicians and RNs to provide them with the necessary medical insights regarding GDM symptoms, diagnosis, and treatment options. In order to gain informed consent from the patients, nurses have to explain the medical reasons for blood glucose testing and screening. Nursing professionals educate patients on the importance of self-monitoring of blood glucose (SMBG) levels focusing primarily on the positive outcomes of SMBG, including “fewer oversized infants and a reduction in weekly maternal weight gain” (Carolan-Olah, 2017, p. 111). Carolan-Olah (2017) concluded that such interventions were successful “in reducing the risks of infant overgrowth, cesarean delivery, and high blood pressure” (p. 111). It is crucial to acknowledge that nurses are crucial in the management of SMBG interventions.
Apart from the general patient education that covers basic concepts and possible health complications, nurses are also involved in dietary interventions. Registered nurses are responsible for providing patients with necessary medical advice regarding their diet choices and physical activity. Based on the research conducted over the past decades, nurses are now equipped with comprehensive guidelines that help them navigate dietary and lifestyle (also known as behavioral) interventions (Carolan-Olah, 2017). Dietary recommendations include incorporating a nutrition plan that would keep blood glucose levels balanced. Nurses advice on increasing daily activity levels, which is an important part of a GDM-related intervention as well. According to Carolan-Olah (2017), registered nurses assist general physicians in improving health promotion behaviors by taking part in behavioral interventions and referring patients to counselors. Such interventions and counseling are often tailored to women’s cultural and social backgrounds, which helps them get the support they need to implement necessary dietary and lifestyle changes.
Impact on the Health of Pregnant Women and Newborns
GDM is the reason for some of the most severe pregnancy complications for both mother and child. These complications include “cesarean delivery, shoulder dystocia, macrosomia, and neonatal hypoglycemia” (Chiefari et al., 2017, p. 899). In addition, women with GDM have a high risk of developing type 2 diabetes, while their offspring have a higher likelihood of becoming obese early in life (Mensah et al., 2019). According to Chiefari et al. (2017), women with prior GDM “have a significantly higher rate of obesity, hypertension and metabolic syndrome, together with altered levels of circulating inflammatory markers” (p. 902). All of the aforementioned conditions serve as primary risk factors for developing cardiovascular disease. The long-term effects of GDM affect children as well. The offspring of GDM mothers are more likely to show greater central adiposity, have abnormally high blood pressure and develop dyslipidemia (Chiefari et al., 2017). Such serious health implications of GDM emphasize the importance of developing comprehensive management and prevention frameworks for GDM.
Ethical and Legal Implications
The process of treating GDM and managing its preventative care implies a number of legal and ethical implications. Nurses are expected to conduct dietary, SMBG, and lifestyle interventions using the traditional ethical principles of beneficence, autonomy, and non-maleficence (Shandera, 2017). GDM, however, is a medical condition that often leads to additional stress since patients are not only concerned for themselves, but for their newborns as well. Nurses face the challenge of providing mothers with all the necessary medical information regarding GDM (informed consent) while minimizing the stress associated with pregnancy in the first place. The name of the disease that includes “diabetes” may mislead patients into thinking that they are obese when, in reality, there is an issue with their blood glucose levels. It is nurses’ ethical responsibility to provide patients and their families with a thorough explanation. Undiagnosed GDM can lead to legal battles since this medical condition might result in irreversible long-term health complications.
References
Carolan-Olah, M. C. (2016). Educational and intervention programmes for gestational diabetes mellitus (GDM) management: An integrative review. Collegian, 23(1), 103-114.
Chiefari, E., Arcidiacono, B., Foti, D., & Brunetti, A. (2017). Gestational diabetes mellitus: an updated overview. Journal of Endocrinological Investigation, 40(9), 899-909.
Mensah, G. P., ten Ham-Baloyi, W., van Rooyen, D., & Jardien-Baboo, S. (2019). Guidelines for the nursing management of gestational diabetes mellitus: An integrative literature review. Nursing Open, 7(1), 78-90.
Shandera, W. X. (2017). Ethical issues attendant with the current pandemic of diabetes. Clinical Diabetes and Research, 1(1), 35-39. Web.