Effects of nutritional nursing intervention based on glycemic load for patient with gestational diabetes mellitus.

OBJECTIVES: To determine the effects of nutritional nursing intervention based on glycemic load (GL) for patients with gestational diabetes mellitus. MATERIAL AND METHODS: One hundred thirty-four patients diagnosed with gestational diabetes mellitus at our hospital were selected from March 2015 to March 2017 and randomly divided into the observation (n = 67) and control groups (n = 67). All of the patients in the observation and control groups received conventional nutritional nursing. In addition, the patients in the observation group received nutritional nursing intervention based on GL. The changes in blood glucose levels and pregnancy outcomes were compared between the two groups after intervention. RESULTS: There were significant differences in fasting blood glucose (FBG) and the 2h postprandial glucose (2hPG) levels between the two groups (P < 0.05). There was a lower incidence of premature delivery, fetal macrosomia, eclampsia, preg- nancy hypertension syndrome, and fetal distress in the observation group. CONCLUSIONS: Nutritional nursing intervention based on GL is more effective than traditional nutritional nursing for patients with gestational diabetes, and can effectively control the blood glucose level, reduce the incidence of pregnant complica- tions, and improve the pregnancy outcome. Thus, nutritional nursing intervention based on GL deserves to be popularized.

Antenatal management of gestational diabetes mellitus can improve neonatal outcomes.

OBJECTIVE: Pregnancies complicated with gestational diabetes mellitus (GDM) are at a higher risk for caesarean and instrumental deliveries as well as adverse neonatal outcomes such as fetal overgrowth, hypoglycaemia and neonatal intensive care admission. Our primary objective was to describe neonatal outcomes in a sample that included term infants of both GDM mothers and mothers with normal glucose tolerance (NGT). DESIGN AND SETTING: this cross-sectional study included 599 term babies born between September and October 2010 at Royal Prince Alfred Hospital, Sydney, Australia. Maternal and neonatal data were collected from medical records and a questionnaire. Glycaemic control data was based on third trimester HbA1c levels and self-monitoring blood glucose levels (BGL). Univariate associations between GDM status and maternal demographic factors, as well as pregnancy outcomes, were estimated using χ(2) tests and t-tests, as appropriate. FINDINGS: of 599 babies, 67(11%) were born to GDM mothers. GDM mothers were more likely to be overweight/obese and of Asian ethnicity. Good glycaemic control was achieved in most GDM mothers. GDM babies were more likely to have been induced (p=0.013) and delivered earlier than non-GDM mothers (p<0.001), and they were also more likely to be breastfed within one hour of birth. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: in this study, GDM infants were more likely to be induced and delivered earlier but otherwise they did not have significantly different neonatal outcomes compared to infants of NGT mothers. This can be attributed to the good GDM control by lifestyle modification and insulin if necessary. The role of labour induction in GDM pregnancies should be further investigated. Midwives have an important role in maternal education during pregnancy and in the postnatal period.

Teoría y cuidados de enfermería: una articulación para la seguridad de la gestante diabética / Theory and nursing care: the articulation for the safety of the diabetic pregnant woman

La atención a la embarazada tiene como objetivo reducir al mínimo el riesgo de morbi mortalidad tanto para la madre como para el niño. La identificación temprana de los factores de riesgo permite una atención más especializada de acuerdo con el factor de riesgo que presente la paciente, y evitar complicaciones. Se realizó este trabajo con el objetivo de vincular la teoría de Ernestine Wiedenbach una de las grandes teóricas que hizo aportes a la enfermería con una de las afecciones que más afectan a las gestantes y las acciones independientes de enfermería, la diabetes mellitus. Se realizó una revisión bibliográfica del tema y de la vida y obra de esta teórica. Se concluyó que el adecuado control metabólico durante la gestación evita complicaciones maternas, fetales y neonatales. El cumplimiento de las acciones dependientes e independientes de enfermería en la gestante con diabetes ayuda a ésta en el control de su afección, y garantiza una seguridad para su salud. El modelo de Ernestine Wiedenbach cumple el objetivo para el que fue desarrollado al describir el ejercicio de la profesión, y contempla éste desde un punto de vista holistico(AU)

The care of pregnancy is aimed at reducing morbidity and mortality risk both for the mother and the child. The early detection of risk factors allows more specialized assistance according to the type of risk factor carried by the patient and prevention of complications. The objective of this paper was to link Ernestine Wiedenbach' s theory - one of the greatest contributions to nursing- with one of the diseases affecting more the pregnant women called diabetes mellitus. A literature review was made on the topic and on the existence and the work of this theory. It was concluded that the adequate metabolic control during pregnancy avoids maternal, fetal and neonatal complications. The fulfillment of independent and depending nursing actions aimed at the pregnant woman suffering from diabetes helps her to manage her illness and assures safe health condition. Ernestine Wiedenbach's model meets the objective for which it was created, since it describes the performance of the profession from a holistic viewpoint(AU)

Teoría y cuidados de enfermería: una articulación para la seguridad de la gestante diabética / Theory and nursing care- the articulation for the safety of the diabetic pregnant woman

La atención a la embarazada tiene como objetivo reducir al mínimo el riesgo de morbi mortalidad tanto para la madre como para el niño. La identificación temprana de los factores de riesgo permite una atención más especializada de acuerdo con el factor de riesgo que presente la paciente, y evitar complicaciones. Se realizó este trabajo con el objetivo de vincular la teoría de Ernestine Wiedenbach una de las grandes teóricas que hizo aportes a la enfermería con una de las afecciones que más afectan a las gestantes y las acciones independientes de enfermería, la diabetes mellitus. Se realizó una revisión bibliográfica del tema y de la vida y obra de esta teórica. Se concluyó que el adecuado control metabólico durante la gestación evita complicaciones maternas, fetales y neonatales. El cumplimiento de las acciones dependientes e independientes de enfermería en la gestante con diabetes ayuda a ésta en el control de su afección, y garantiza una seguridad para su salud. El modelo de Ernestine Wiedenbach cumple el objetivo para el que fue desarrollado al describir el ejercicio de la profesión, y contempla éste desde un punto de vista holistico(AU)

The care of pregnancy is aimed at reducing morbidity and mortality risk both for the mother and the child. The early detection of risk factors allows more specialized assistance according to the type of risk factor carried by the patient and prevention of complications. The objective of this paper was to link Ernestine Wiedenbach' s theory - one of the greatest contributions to nursing- with one of the diseases affecting more the pregnant women called diabetes mellitus. A literature review was made on the topic and on the existence and the work of this theory. It was concluded that the adequate metabolic control during pregnancy avoids maternal, fetal and neonatal complications. The fulfillment of independent and depending nursing actions aimed at the pregnant woman suffering from diabetes helps her to manage her illness and assures safe health condition. Ernestine Wiedenbach's model meets the objective for which it was created, since it describes the performance of the profession from a holistic viewpoint(AU)

Attitudes towards gestational diabetes among a multiethnic cohort in Australia.

AIMS: This study aimed to examine the attitudes and beliefs towards gestational diabetes of a multiethnic sample of pregnant women with gestational diabetes. BACKGROUND: Women from non-Caucasian background are disproportionately represented in gestational diabetes statistics. This is of particular importance in multicultural Australia, where increasing numbers of non-Caucasian women give birth. DESIGN: Cross-sectional survey. METHODS: The Diabetes Attitude Scale, version 3 was administered to 200 women with gestational diabetes from Vietnamese, Indian, Filipino and Caucasian backgrounds. RESULTS: A total of 143 questionnaires were returned indicating a response rate of 71·5%. There were significant between group differences in terms of educational level (p = 0·001) and English fluency (p = 0·001). Lower educational level, though not English language fluency, was associated with poorer appreciation of gestational diabetes as a serious condition and also with a lower valuing of tight glucose control. This effect was seen irrespective of ethnic group. Indian and Vietnamese women indicated a lower valuing of patient autonomy and also reported less negative psychological effects than Caucasian and Filipino women. CONCLUSIONS: Women from non-Caucasian ethnicities may be at risk of poorer self-management of gestational diabetes related to lower education, lower health literacy and a lower appreciation of gestational diabetes as a serious condition. RELEVANCE TO CLINICAL PRACTICE: Nurses and midwives provide information and advice to women with gestational diabetes. Knowledge about factors that impact on attitude towards gestational diabetes among multiethnic populations is important for developing educational programmes to address their needs.

Diabetes in pregnancy--dietary management.

The provision of adequate energy and nutrients in the woman with DM is essential for normal fetal growth. However, dietary modifications including exercise are essential to normalise blood glycaemic levels and prevent adverse pregnancy outcomes. However, the evidence surrounding the nutritional management in GDM has been controversial. Dornhorst and Frost (2002) state that not only are there conflicting guidelines on nutritional management but disagreement as to the effectiveness of this on pregnancy outcomes. NICE (2008) has issued guidelines on the management of DM before, during and after pregnancy. Dietary prescriptions should include personal preference, body weight and type and level of exercise, blood glucose levels, ketone levels and any medications taken for the DM. Midwives must empower women to manage their condition through making appropriate and acceptable choices for their health and that of their baby.

Beliefs about health and illness in women managed for gestational diabetes in two organisations.

OBJECTIVE: to explore beliefs about health, illness and health care in women with gestational diabetes mellitus (GDM) managed in two different organisations based on diabetology or obstetrics. DESIGN: an explorative qualitative study using semi-structured interviews. SETTING: clinic A: a specialist diabetes clinic with regular contact with a diabetologist and antenatal care provided by a midwife; clinic B: a specialist maternity clinic providing regular contact with a midwife, a structured programme for self-monitoring of blood glucose and insulin treatment, and a 1-day diabetes class by an obstetrician, a diabetologist, a midwife and a dietician. The clinics were located at two different university hospitals in Sweden. PARTICIPANTS: a consecutive sample of Swedish women diagnosed with GDM; 13 managed in clinic A and 10 managed in clinic B. MEASUREMENT AND FINDINGS: women described their perceptions of as well-being, being healthy and freedom from disease. All respondents reported a delay in the provision of information about GMD and an information gap about GDM and the management of the condition, from diagnosis until the start of treatment at the specialist clinic. Respondents from clinic A expressed fear about future development of type 2 diabetes. Women from clinic B discussed different causes of GDM, and many claimed that health-care staff informed them that GDM was a transient condition during pregnancy. Respondents from clinic A reported a conflict in their treatment of pregnancy and GDM as two different conditions. KEY CONCLUSIONS: beliefs differed and were related to the health-care model chosen. Women with GDM monitored at a specialist maternity clinic believed GDM to be a transient condition during pregnancy only, whereas women monitored at a diabetes specialist clinic expressed fear about a future risk of developing type 2 diabetes. IMPLICATIONS FOR PRACTICE: relevant information about GDM should be provided without delay after initial diagnosis and thereafter repeatedly. It is important to recognise the context of information given on GDM, as it will substantially influence the beliefs and attitudes of women towards GDM as a transient condition during pregnancy or as a potential risk factor for diabetes.

Teoria do cuidado humano: análise crítica e possibilidades de aplicação a mulheres com diabetes gestacional / The theory of human care: critical analysis and possible applications for women with pregnancy diabetes

Objetivou-se analisar a Teoria do Cuidado Humano e discorrer sobre as possibilidades de sua aplicação no cuidado a mulheres com diabetes gestacional (DG). Utilizou-se o modelo de Análise Crítica de teorias, elaborado por Chinn e Kramer. Constatou-se que a teoria em questão, uma vez valorizando o trinômio mente/corpo/espírito, centraliza-se numa perspectiva humanista, favorecendo o cuidado transpessoal e colocando a enfermagem como provedora do cuidado holístico necessário ao crescimento e desenvolvimento do homem. Concluiu-se que essa Teoria pode ser aplicada no cuidado a mulheres com DG, visto que seus pressupostos alertam as enfermeiras para que priorizem, no processo de cuidar, o cuidado clínico com amor e carinho e não o estado patológico em si.

Caring for a woman at high risk for type 2 diabetes.

Women who are obese with a history of gestational diabetes are at risk for developing type 2 diabetes and metabolic syndrome. A weight loss of as little as 15 pounds can decrease these long-term risks. This case presentation reviews practical issues related to encouraging women to make important lifestyle changes and to adhere to taking cholesterol-lowering medications.

Swedish and Middle-Eastern-born women's beliefs about gestational diabetes.

OBJECTIVE: to compare beliefs about health and illness between women born in Sweden and the Middle East who developed gestational diabetes (GD). DESIGN: a qualitative, explorative study using semi-structured interviews. SETTING: in-hospital diabetes specialist clinic in Sweden. PARTICIPANTS: consecutive sample of women with GD; 13 born in Sweden and 14 born in the Middle East. MEASUREMENT AND FINDINGS: all the women described health as freedom from disease, and expressed worries for the baby's health and well-being. Women from the Middle East did not know the cause of GD, discussed the influence of social factors, such as being an immigrant, and supernatural factors, tried to adapt to the disease and thought it would disappear after birth, felt they had more pregnancy-related complications but had not received any treatment. Swedish women attributed GD to inheritance, environment and hormonal change, feared developing Type 2 diabetes, found work-related stress harmful to their health, more often sought help, used medications against pregnancy-related complications, and were more often on sick-leave from work. KEY CONCLUSIONS: Swedish women initiated a battle against GD, demanded medical treatment for pregnancy-related complications because of gainful employment and viewed pregnancy as a disease. Women from the Middle East temporarily adapted to the disease and perceived pregnancy and related problems as a natural part of life. IMPLICATIONS FOR PRACTICE: it is important to assess individual beliefs, risk awareness and to meet individual needs for information.

Evidence-based diabetes screening during pregnancy.

The concept of gestational diabetes was described more than a half century ago and has been studied extensively for more than 30 years. Available data indicate that the prevalence is highly variable, probably reflecting underlying risk factors. In addition, gestational diabetes is not a specific disease, but rather an abnormal laboratory value. Criteria for diagnosis are variable, and there is little agreement about who should be screened, if screening should be selective or universal, or how screening should be performed. Moreover, the most commonly used criteria in the United States differ from the European and World Health Organization standard criteria. This article describes the background for diabetes testing, current evidence for testing and diagnosis in pregnant women, "risks" of diagnosis, and various screening procedures and protocols, using data-based evidence when available. Midwifery practice recommendations are also made, including examination of risk factors as clinical decisions are made about guidelines.