{
  "name": "Gestational Diabetes Mellitus",
  "slug": "gestational-diabetes",
  "url": "https://nursingplex.com/care-plans/gestational-diabetes",
  "category": "Endocrine & Metabolic",
  "summary": "Pregnancy-onset glucose intolerance; diet, monitoring and fetal surveillance.",
  "nursing_diagnoses": [
    "Risk for unstable blood glucose",
    "Risk for fetal injury",
    "Deficient knowledge"
  ],
  "overview": [
    "Gestational diabetes mellitus is glucose intolerance first recognized in pregnancy, caused by placental hormones — human placental lactogen, cortisol, progesterone — that create insulin resistance the mother cannot fully offset. It typically appears in the second half of pregnancy and is screened for at 24–28 weeks.",
    "Maternal hyperglycemia crosses the placenta and stimulates fetal insulin production, producing macrosomia, birth trauma, neonatal hypoglycemia after delivery, hyperbilirubinemia and respiratory distress. Mothers face higher risks of preeclampsia, cesarean birth and future type 2 diabetes.",
    "Nursing care emphasizes self-monitoring of blood glucose, medical nutrition therapy, safe activity, insulin teaching when needed, and close fetal surveillance."
  ],
  "key_facts": [
    {
      "label": "Typical targets",
      "text": "Fasting below 95 mg/dL, one hour after meals below 140, two hours below 120."
    },
    {
      "label": "Drug of choice",
      "text": "Insulin is preferred in pregnancy because it does not cross the placenta."
    },
    {
      "label": "Newborn watch",
      "text": "Check the infant's glucose soon after birth — fetal hyperinsulinemia causes rapid hypoglycemia."
    },
    {
      "label": "Postpartum",
      "text": "Re-screen with a 75 g oral glucose tolerance test 4–12 weeks after delivery."
    }
  ],
  "nursing_priorities": [
    "Achieve and maintain target glucose levels.",
    "Teach accurate self-monitoring and, when needed, insulin administration.",
    "Provide individualized nutrition and activity guidance.",
    "Monitor fetal growth and well-being.",
    "Prepare for intrapartum glucose control and newborn monitoring."
  ],
  "assessment": {
    "subjective": [
      "Reports of increased thirst, hunger or urination",
      "Reports of fatigue or blurred vision",
      "Concerns about injections, diet limits and effects on the baby",
      "Diet recall and activity pattern"
    ],
    "objective": [
      "Abnormal glucose challenge or 3-hour tolerance test results",
      "Home glucose log values relative to targets",
      "Fundal height greater than expected for dates; estimated fetal weight on ultrasound",
      "Blood pressure, urine protein and weight gain pattern",
      "Nonstress test and biophysical profile results"
    ],
    "related_factors": [
      "Placental hormone-induced insulin resistance",
      "Pre-pregnancy obesity or excessive gestational weight gain",
      "Family history of type 2 diabetes; prior GDM or macrosomic infant",
      "Sedentary lifestyle and high-carbohydrate diet"
    ]
  },
  "goals": [
    "The client will maintain fasting and postprandial glucose within target ranges.",
    "The client will demonstrate correct glucose testing and insulin technique.",
    "The client will gain weight within recommended limits.",
    "The client will give birth to an infant of appropriate size without complications."
  ],
  "interventions": [
    {
      "title": "Glucose management",
      "points": [
        "Teach and verify fingerstick technique and logging four times daily.",
        "Review the log at every visit and report persistent values above target.",
        "Administer or teach insulin with correct site rotation and storage.",
        "Teach hypoglycemia recognition and the 15-15 rule."
      ]
    },
    {
      "title": "Nutrition and activity",
      "points": [
        "Refer to a dietitian for a carbohydrate-controlled plan with three meals and two to three snacks.",
        "Emphasize complex carbohydrates, protein pairing and a small bedtime snack to prevent morning ketosis.",
        "Encourage 20–30 minutes of walking after meals unless contraindicated.",
        "Monitor weight gain against Institute of Medicine recommendations."
      ]
    },
    {
      "title": "Fetal and intrapartum surveillance",
      "points": [
        "Teach daily fetal movement counting.",
        "Support scheduled ultrasounds and antenatal testing.",
        "During labor, monitor maternal glucose hourly and follow insulin-dextrose protocols.",
        "Anticipate neonatal glucose checks and early feeding after birth."
      ]
    }
  ],
  "patient_teaching": [
    "Explain that GDM usually resolves after birth but raises lifetime type 2 diabetes risk.",
    "Stress the 4–12 week postpartum glucose tolerance test and annual screening afterward.",
    "Encourage breastfeeding, which improves maternal glucose metabolism.",
    "Review long-term weight, diet and exercise strategies for prevention."
  ]
}