Please enable JavaScript.
Coggle requires JavaScript to display documents.
Additional needs - Gestational diabetes. 2400 words, Conclusion 300 words,…
Additional needs - Gestational diabetes. 2400 words
Cultural, social, psychological, physical and spiritual
Respect maternal wishes.
Some woman can't make it through the OGTT without throwing up.
Cultural
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9967365/#:~:text=Women%20reported%20that%20testing%20and,perceived%20as%20depriving%20the%20baby
May be a carb heavy diet.
Diet modifications can be seen as depriving the baby.
Visiting family and friends feeling obliged to eat food prepared for them.
Cooking different types of meals for family and friends.
Psychological and social.
May cause stress and anxiety.
https://id.elsevier.com/as/authorization.oauth2?platSite=SD%2Fscience&scope=openid%20email%20profile%20els_auth_info%20els_idp_info%20els_idp_analytics_attrs%20els_sa_discover%20urn%3Acom%3Aelsevier%3Aidp%3Apolicy%3Aproduct%3Ainst_assoc&response_type=code&redirect_uri=https%3A%2F%2Fwww.sciencedirect.com%2Fuser%2Fidentity%2Flanding&authType=SINGLE_SIGN_IN&prompt=login&client_id=SDFE-v4&state=retryCounter%3D0%26csrfToken%3D916a2b30-0a58-45c7-9656-bd3267b60f32%26idpPolicy%3Durn%253Acom%253Aelsevier%253Aidp%253Apolicy%253Aproduct%253Ainst_assoc%26returnUrl%3D%252Fscience%252Farticle%252Fabs%252Fpii%252FS1751991821001753%26prompt%3Dlogin%26cid%3Darp-35d83160-3c45-41cd-927d-89a3d8479a3b#:~:text=Studies%20have%20also%20shown%20that,gain%20during%20pregnancy%20%5B12%5D
GDM is associated with antepartum and postpartum depression, reenforcing the important role of the phycological support.
May need more social support.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9672204/
Lack of social support may lead to adverse outcomes.
role of spouse / key members of the family are important.
Social support plays a mediating role between anxiety and life satisfaction within pregnant women.
Social side is a protective factor.
Explanation of what social support is.
Low socioeconomic status may lead to being less likely to seek further care and support.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809300/
Physical.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503359/#:~:text=However%2C%20any%20type%20of%20physical,at%20a%20least%20moderate%20intensity
Exercise for 20- 30 mins a few times a week.
Supervision is advised.
Sedentary behaviour can lead to additional risk of GDM.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515443/
Spiritual.
Engaging in spiritual therapy can help reduce anxiety and improve quality of life.
https://www.semanticscholar.org/paper/The-effect-of-spiritual-counseling-on-improving-of-MonfaredKashki-Maleki/716bc65f27bdcb1b6f0406ed81a3c9a46a3b232a
file:///C:/Users/Lenovo/Downloads/FMPCR_Art_42271-10%20(1).pdf
Fasting can be part of spiritual.
Role of midwive
NMC code of conduct 2018 section 3, 8, 9, 10,
NMC standards of proficiency 2019, domain 4 and 6
MDT.
Referrals.
To consultant.
GDM clinic / specialist midwife.
Nutritionist / dietitian.
GP.
Risk assessment and management
NICE guidelines 2020.
Indicators.
BMI 30 or above.
Previous Macrosomic baby. 4.5kg or more.
Previous GDM.
Family history of GDM.
Ethnicity with prevalence of diabetes.
Testing.
OGTT. 75g, 2 hours.
Done between 24-28 weeks of gestation.
If previous GDM - early self-monitoring of blood glucose.
Diagnosis.
If fasting plasma glucose level of 5.6 mmol/litre or above
2 hour OGTT plasma glucose level of 7.8mmol/litre or above
Targets.
Fasting 5.3 mmol/litre
1 hour after meal 7.8 mmol/litre
2 hours after meal 6.4 mmol/litre
If taking insulin maintain level above 4mmol/litre
Management/ interventions.
Inform the woman of the short and long term risks to her and her baby.
Fetal macrosomia.
Trauma during birth for both her and/or the baby.
Induction of labour.
LSCS.
Neonatal hypoglycaemia.
Perinatal death.
Self-monitoring.
same capillary plasma glucose target levels for women with gestational diabetes as for women with pre‑existing diabetes
Taylor therapy to blood glucose profile and maternal preference.
Offer advice on diet and lifestyle changes.
Low glycaemic index foods.
Regular exercise, e.g. walking 30 mins after meaal.
If targets not met in 1 - 2 weeks offer metformin, or insulin if metformin in contraindicated.
If targets still not met with diet, exercise and metformin offer insulin additionally.
Conclusion 300 words
Summarise the complications GDM can cause.
Summarise the treatments for these complications.
How learning contributes to developing practice
Summarise why a MDT approach works
Figures / statistics
Don't introduce new subjects.
Introduction 300 words
brief overview of woman
28 Years old
Her mother no GDM. Sister had diet controlled GDM
2nd pregnancy
No GDM in previous pregnancy
introduce pseudonym and confidentiality
Pregnant woman Louise Smith. Midwife Jane Jones.
Duty of confidentiality.
Extends beyond GDPR and DPA 2018. And beyond death
Declaration of accountability for confidentiality and professional practice
The NHS Act 2006 section 251.
The Health and Social care Act 2012 section 263