During my clinical practicum, I encountered a pregnant patient, Ms. Akinyi, a 32-year-old G2P1 at 28 weeks gestation, who was diagnosed with Gestational Diabetes Mellitus (GDM) during her routine glucose tolerance test. Her previous pregnancy was complicated by macrosomia, a key risk factor for recurrent GDM.

1. Define and Describe the Health Condition: Gestational Diabetes Mellitus (GDM)

Definition and Description: Gestational Diabetes Mellitus (GDM) is a carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. It occurs when the body, specifically the placenta, produces hormones that block the action of the mother’s insulin (insulin resistance). Normally, the pancreas compensates by producing more insulin, but in GDM, the pancreas cannot produce enough to overcome this resistance, leading to elevated blood glucose levels. Unlike Type 1 or Type 2 Diabetes, GDM typically resolves after delivery, but it signifies a higher risk for the mother to develop Type 2 Diabetes later in life and for the child to experience long-term health issues.

Health Impact for the Mother:

• Preeclampsia and Gestational Hypertension: GDM increases the risk of developing high blood pressure and preeclampsia, a serious pregnancy complication that can lead to severe morbidity and mortality for both mother and fetus.
• Increased Risk of Cesarean Section: Due to the potential for macrosomia (large baby), there is a higher likelihood of needing a Cesarean section, which carries risks of surgical complications, longer recovery, and future pregnancy complications.
• Macrosomia and Birth Trauma: High maternal glucose levels lead to excessive glucose transfer to the fetus, causing the fetal pancreas to produce more insulin, which in turn promotes excessive growth (macrosomia). This increases the risk of shoulder dystocia (baby’s shoulder getting stuck during delivery), leading to birth injuries for both mother (e.g., severe perineal lacerations) and baby (e.g., brachial plexus injury).
• Polyhydramnios: Excessive amniotic fluid can occur due to fetal hyperglycemia leading to polyuria, increasing the risk of preterm labor and premature rupture of membranes.
• Future Diabetes Risk: Women with a history of GDM have a significantly increased risk (up to 71%) of developing Type 2 Diabetes Mellitus within 5-10 years postpartum. They also have a higher chance of recurrence in future pregnancies.
• Increased Risk of Infection: Elevated blood glucose levels can impair immune function, leading to a higher susceptibility to infections like urinary tract infections or yeast infections.

Health Impact for the Fetus/Neonate:

• Macrosomia: As described above, leading to birth trauma and potential need for C-section.
• Neonatal Hypoglycemia: After birth, the baby, having been accustomed to high glucose levels in utero, continues to produce high insulin levels. When the constant glucose supply from the mother is cut off, the neonate’s blood sugar can drop dangerously low, potentially leading to seizures or brain damage if not promptly managed.
• Respiratory Distress Syndrome (RDS): High insulin levels in the fetus can delay lung maturation, increasing the risk of respiratory distress at birth, especially if born prematurely.
• Hyperbilirubinemia and Polycythemia: Increased red blood cell production in response to fetal hypoxia (due to increased oxygen demand from larger size) can lead to higher bilirubin levels after birth, potentially causing neonatal jaundice.