Postpartum Management for Gestational Diabetes Mellitus - Essay Example

Postpartum Management for Gestational Diabetes Mellitus al Affiliation) Specific Issue Gestational diabetes mellitus isa medical condition characterized with the onset glucose intolerance during pregnancy .It is recorded as the foremost common metabolic disorder and complication during pregnancy, with reported estimates of 1-14% of cases in each population. It occurs among women who have insulin resistance and a relative impairment of insulin. Such women have a higher predisposition of developing type 2 diabetes later in life. The identification of such women is important in improving the health of the mother and child and preventing prenatal morbidity. Added advantages include the ability to educate and treat the women while equipping them with skills to cope with the condition. Since type 2 diabetes is preventable with the correct lifestyle changes, pregnant women represent an ideal focus group in the pursuit of ways of delaying or preventing the progression of type 2 diabetes. Preventive measures are hindered by poor primary care efforts of detecting diabetes, poor practice recommendations, lack of awareness on the need to institute lifestyle changes, and a lack of adherence to the set guidelines by health care providers. Reviewing the pathogenesis of gestational diabetes mellitus, clinical practice recommendations by institutions like the American College of Obstetricians and Gynecologists, links to diabetes after pregnancy and adherence to guidelines is crucial. HealthCare Practice The American College of Obstetricians and Gynecologists (ACOG) is on the forefront of setting guidelines that are followed when dealing with the management of gestational diabetes mellitus. Despite the advantages of the 1-step approach, there have been claims of it increasing the frequency of gestational diabetes by two to three times. This is supported by the fact that, roughly 280 million women develop gestational diabetes mellitus every year in the US, which represents 7% of the total population of women giving birth. This is partly due to the increase in obesity levels in the general population and the increased number of women in advanced years giving birth. Other risk factors include being genetically predisposed to diabetes due to ethnicity and family medical problems. The need for a 2-step approach is therefore warranted. The approach is based on screening the administration of a 50g oral solution accompanied by a venous glucose for 1 hour. Women that range around or above the put threshold, are subjected to an oral diagnostic glucose tolerance test for 3 hours. The test is normally conducted in all pregnant women between 24 and 28 weeks of gestation. ACOG recommends the test since women with gestational diabetes are more susceptible to hypertension, caesarian associated morbidities and 7 times more likelihood of developing diabetes in their later lives. ACOG has also proposed the introduction of new performance measures in women that have been diagnosed with gestational diabetes. The method involves the use of nutritional counselling by a registered dietitian to monitor the diet of the women and advice on an appropriate routine exercise regimen. Blood glucose levels used should range from 135-140 mg/dL, putting in mind factors like prevalence rates of the diabetes in order to determine the cut off level. Pros and Cons An estimated 60 % of the population in USA is classified as obese, highlighting the need for the implementation of prevention programs across the country. An elaborate program offering a wide range of preventive care including weight management through diet, exercise and medical advice will aid in the fight against obesity. The quality of life of at risk diabetics is bound to be improved while avoiding other lifestyle related diseases like eye disorders, kidney diseases, heart attacks, and strokes. Additional benefits include the costs to be saved by insurance companies and patients in the end, from preventing progression of diabetes. It is of worth to note that 25% of the healthcare spending budget is channeled towards treating diabetes and other complications related to the disease. Comprehensive healthcare provided to women in their child bearing years will reduce their susceptibility to developing type 2 diabetes by close to 60%.This is over a time frame of three to four years. The cost benefits of providing the care is estimated to be over $300 million in ten years and a reduction in the conversion of gestational diabetes mellitus to type 2 diabetes by half. The implications of such a practice are both economical and will aid in curbing progression of diabetes to at risk women. Health care providers should be very keen on this issue. Stakeholders in the health industry should be keen on detecting the disease and its management. Thomas et al suggests that, intensified treatment needed for the treatment of GDM may tempt clinicians to be less keen especially after delivery of the child. The clinicians rely on the assumption that management of the disease is no longer necessary which may inhibit the opportunity for the improvement of the health of the mother and the child. Encouraging women to breastfeed their newborn babies has the advantage of strengthening the immune system of the child. Long-term benefits of breastfeeding include reduced risk levels of obesity and glucose intolerance. Choosing and development of a contraception method that does not increase the risk of glucose intolerance levels in mothers will go a long way in the overall prevention of GDM and lower the risk of new mothers developing type 2 diabetes (Thomas, 2005). Treatment for women with GDM should be in accordance with the guidelines of the American Diabetes Association and other recognized organizations. The treatment should also be adjusted to cater for the needs of lactation. A percentage of the women with GDM will be prone to persisting hyperglycemia after delivery necessitating medical care for hypertension, diabetes, and dyslipidemia. With that in mind, treatment should be managed carefully in order to reduce the risks associated with subsequent pregnancies. Personal Position The surveillance of the blood glucose levels of the women with gestational diabetes should begin once one is on nutrition therapy, in order to ensure that glycemic control is established. If the required glucose levels are not attained through therapy and nutrition, a pharmacological treatment is indicated. After indication, the first line of therapy to be used should be oral and insulin medications. Up to one third of women after delivering the baby have impaired glucose metabolism at the postpartum screening recommended after a period of 2 months (Queenan, 2012). Published recommendations by ADA suggest the need for women with gestational diabetes mellitus to be re classified after 6 weeks when persistent glucose abnormalities are detected. Those women that maintain glucose intolerance after pregnancy should be subject to an annual glucose test. Tests should be followed by regular exercises and intensive medical nutrition teaching. Emphasis should be placed in educating patients on lifestyle changes for reducing the risk of insulin resistance and weight gain. Patients that develop symptoms of hyperglycemia should seek medical attention immediately. Guidelines for dealing with the children of women that have GDM need to be monitored closely in case they develop obesity or other complications that result from glucose tolerance. Measures for care have been recommended by ACOG like referring patients to nutritionists. The other issue is how to tackle the lack of follow up by patients suffering from GDM. This is attributed partly to the absence of a system of monitoring primary care in a population that is largely young and mobile. The lack of follow up puts the women at risk of developing type 2 diabetes especially after giving birth. Factors such as hectic lifestyles associated with motherhood, denial, fear of needles have been attributed to a lack of follow up. According to Coulston, primary care givers have been at fault in providing advice on issues like weight loss, exercise, and diet on a consistent capacity. It has led to increased progression of diabetes among the new mothers. The development of features like clinician-in-service education, computerized medical records of patients, reminder systems and standing orders have been scientifically proven to aid in enhancing clinicians to follow guidelines set in place (Coulston, 2008). Policy implications Conclusion GDM has the potential to lead to the development and progression of diabetes type 2 with varying negative consequences bound to affect the whole society. It should be noted that there is a general lack of awareness regarding the available prevention measures that are available to prolong the lives of the at risk women. Identification of these women is vital in not only preventing prenatal morbidity but also improving the healthcare and lives for both the mother and child. Preventive measures if applied properly, have the potential to save a lot of money for both the individual and the health care system as a whole. By adopting the preventive measures keenly, the need for patients to adhere to strict regimens of exercise, dietary restrictions, medication will be resolved. Life threatening complications associated with diabetes like neuropathy, retinopathy, heart disease and nephropathy will be dealt with. Women with GDM should be encouraged and trained on healthy nutrition, healthy weight loss, cessation of smoking, promotion of breastfeeding, appropriate use of contraceptives, planned exercise routines especially after the initial postpartum. The future appears bright if, the government, medical staff, health bodies, caregivers and at -risk mothers adopt preventive measures diligently. However, if one has already been diagnosed with GDM or diabetes type 2, follow the medical advice prescribed fully for a prolonged life. References Coulston, A. (2008). Nutrition in the prevention and treatment of disease (2nd Ed.). Amsterdam: Academic Press. Thomas, A., & Gutierrez, Y. (2005). American Dietetic Association guide to gestational diabetes mellitus. Chicago: American Dietetic Association Queenan, J. (2012). Queenans management of high-risk pregnancy an evidence-based approach (6th Ed.). Chi Chester: Wiley-Blackwell Read More