Atención de enfermería en complicaciones metabólicas del recién nacido hijo de madre con diabetes pregestacional / Nursing care in metabolic complications of the newborn child from mothers with pregestational diabetes

La atención de enfermería es esencial ante la presencia de diabetes pregestacional. Se realizó un estudio retrospectivo, descriptivo y transversal en el Hospital Materno «Mariana Grajales¼ (enero 2015- enero 2018). El universo fue la totalidad de neonatos hijos de madres con diabetes pregestacional (41). Una de las principales complicaciones maternas según tipo de diabetes pregestacional fue la tipo 1. En la diabetes tipo 2, 21 (51,3 %) no presentaron complicaciones. En cuanto a las complicaciones del recién nacido; en la diabetes tipo 1, el 9,8% no presentaron complicaciones, 4 (9,8 %) presentaron macrosomia, seguida de la hipoglucemia en 3 (7,3 %) y la hipocalcemia en 2 (4,8 %); en la tipo 2, 8 (19,5 %) no presentaron complicaciones y 8 (19,5 %) presentaron macrosomia. Las intervenciones de enfermería más utilizadas fueron: cuidados del recién nacido (6 880); alimentación (1 050) y educación sanitaria (5 510). Las complicaciones más frecuentes: macrosomia fetal, hipoglucemia e hipocalcemia.

Blood tests for investigating maternal wellbeing. 7. Testing for diabetes in pregnancy.

Increase in obesity and prevalence of diabetes has made this condition the most common and important metabolic disorder. Midwives regularly meet women at booking whose pregnancy will be or is complicated by diabetes. These women and their babies are at increased risk of morbidity not just during pregnancy and birth but for long term as well. The article takes you briefly through the condition and updates you on the relevant guidelines and tests you may offer woman who is at risk of or has diabetes in pregnancy. Early diagnosis may enable intervention that may result in improved perinatal outcome.

Developmental considerations in working with newborn infants of mothers with diabetes.

Infants of diabetic mothers (IDMs) are at risk for an altered developmental course beginning with physiologic alterations in utero. This article describes physiologic and behavioral factors that impact the fetus and newborn infant and may have long-term developmental consequences. A clinical reasoning process to support development optimizes the outcomes of IDMs while in the NICU. Specific interventions are suggested.

Caring for the infant of a diabetic mother.

In the United States, approximately 100,000 infants are born to diabetic mothers each year. If diabetes in pregnancy is uncontrolled, the diversity of resulting health problems can have a profound effect on the embryo, the fetus, and the neonate. These infants are at risk for a multitude of physiologic, metabolic, and congenital complications such as macrosomia, asphyxia, respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia and hyperviscosity, cardiomegaly, and central nervous system disruption. Preconception control of glucose metabolism throughout the trajectory of a woman's pregnancy is a significant factor in decreasing the adverse impact of diabetes on the fetus and newborn. Meticulous attention to neonatal glucose levels, thorough physical examination, and precise diagnosis are prerequisites to appropriate care for the neonate.

The future role for a diabetes specialist midwife.

In the United Kingdom diabetes is now the most common, pre-existing medical disorder in pregnancy [Jincoe A. Diabetes: monitoring maternal and fetal wellbeing. Br J Midwifery 2006;14(2):91-4], and still continues to have associated risks for the mother, fetus and neonate [Confidential Enquiry into Maternal and Child Health. Diabetes in pregnancy: are we providing the best care? Findings of a national enquiry: England, Wales and Northern Ireland. London: CEMACH; 2007]. Worldwide diabetes is becoming more prevalent [Macfarlane A. Diabetes and pregnancy. Br Med J 2006;333(7560):157-8] and there is the added new phenomenon of the increase in Type 2 diabetes in the childbearing population. The midwifery role in such pregnancies has come under question as some units have Diabetes Specialist Midwives and some do not and midwifery care is presently varied [Miller A. Diabetes: lessons for midwives. Pract Midwife 2005;8(11):4-5]. This review will specifically seek to address the midwifery role in relation to this client group with complex needs. It will explore how a specialist midwifery post could have an impact on improving care, how the role is developing and future perspectives. Aspects on how midwifery care is delivered to women with diabetes in the United Kingdom will be discussed and a brief international insight relayed.

Juggling type 1 diabetes and pregnancy in rural Australia.

OBJECTIVE: to explore the experiences of women with type 1 diabetes, living in rural Australia, while preparing for pregnancy and childbirth. Additionally, we aimed to describe the women's engagement with, and expectations of, health-care providers during this period, and subsequently highlight potential service and informational gaps. DESIGN: qualitative research using a collective case-study design; seven women with type 1 diabetes who had given birth within the previous 12 months participated in in-depth interviews about their experiences of pregnancy and birth. Data were analysed thematically. SETTING: The experience of type 1 diabetes, preconception preparation and pregnancy among rural Australian women was explored, including interactions with health professionals. PARTICIPANTS: seven women aged between 26 and 35 years agreed to be interviewed. The woman had one or two children and had given birth within the past 12 months. FINDINGS: rigid narrow control of blood glucose levels before conception and during pregnancy created unfamiliar body responses for women, with hypoglycaemic symptoms disappearing or changing. For example, some women mentioned developing tunnel vision or numbness and tingling around their lips and tongue as different symptoms of hypoglycaemia. Women needed information and support to differentiate between what might be normal or abnormal bodily processes associated with pregnancy, diabetes, or both. The women's preparation for conception and pregnancy was reliant on the level of available expertise and advice. Participants' experiences were coloured by their limited access and interactions with expert health professionals. CONCLUSION: women with type 1 diabetes experienced significant hardship during their pregnancy, including a higher incidence of hypoglycaemic episodes, a loss of hypoglycaemic symptom recognition and weight gain. These difficulties were compounded by a scarcity of available information to support the management of their pregnancy and a lack of availability of experienced health professionals. IMPLICATIONS FOR PRACTICE: national and international consensus guidelines emphasise the importance of preconception and pregnancy care for women with type 1 diabetes. Close clinical supervision and the development of closer co-operation and partnership between the women and health-care providers before conception and during pregnancy may improve outcomes for these women and their babies. Building confidence in professional care requires increased access to specialist services, increased levels of demonstrated knowledge and expertise and better general community access to information about preparation for pregnancy and birth among women who have type 1 diabetes.

Diabetes: lessons for midwives.

This study is larger than any other in describing pregnancy outcomes for women with pre-gestational diabetes. From the report, the three main messages for midwives are: Women with type 2 diabetes have a risk of poor outcome similar to those with type 1 diabetes. The same support and management of women with type 1 diabetes should be applied to women with type 2 diabetes pre-conceptionally and throughout the pregnancy and neonatal period. Pre-pregnancy care and advice should be made more flexible and advertised well in a variety of settings where diabetic women of childbearing age are most likely to see it. Women with diabetes should be encouraged and supported to breastfeed their babies from birth by giving them an understanding of the general and specific benefits this will provide.

Reliability of reporting of self-monitoring of blood glucose in pregnant women.

OBJECTIVE: To determine the accuracy of reporting of self-monitored blood glucose in pregnant women with diabetes. DESIGN: A descriptive study. Patient-recorded logs of self-monitored blood glucose values were compared to meter memory values. SETTING AND PARTICIPANTS: A convenience sample of 85 pregnant women with pregestational and gestational diabetes enrolled in a perinatal diabetes program in an urban teaching hospital. RESULTS: Accuracy significantly differed by diabetes type (p = .015). Women with type 1 diabetes did not accurately record on average 36.7% of blood glucose values as compared to 8.5% of type 2, 21.2% of GDMA(1) (gestational diabetes mellitus, diet controlled), and 23.4% of GDMA(2) (gestational diabetes mellitus, insulin controlled). Age positively affected accuracy, but accuracy was not affected by marital status, educational background, or duration of diabetes. Statistical significance was shown between values from women with private health insurance and women with Medicaid. Eighty percent of the sample overreported by adding phantom values in the logbook, which did not differ by diabetes type. Approximately 70% underreported by not logging values in the meter memory that was statistically significant by diabetes type. CONCLUSION: Assessment of the reliability of self-monitored blood glucose results from pregnant women with diabetes is recommended owing to a significant degree of falsification.

Diabetes in pregnancy: the midwifery role in management.

Although the primary focus of midwifery is on uncomplicated pregnancy, all midwives must screen for and, in some cases, comanage the care of women with diabetes mellitus and gestational diabetes. This article will review the types of diabetes, implications for preconceptional and pregnancy care, the changing recommendations relative to diabetes in pregnancy, and the role of the midwife in providing antepartal and intrapartal care for women with diabetes in collaboration with other health care professionals and in accordance with the philosophy and standards of the American College of Nurse-Midwives. A specific case study will highlight the role of the midwife, with an overall focus on medical consultation, collaboration, and referral, as well as client involvement in the planning of care.