Report fasting glucose consistently above 95 mg/dL or postprandial values above target, indicating poor control.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse reviews the diagnostic workup for gestational diabetes. Using the 3-hour 100-g oral glucose tolerance test, how many abnormal values are required to confirm the diagnosis?
Answer: B. On the 3-hour 100-g oral glucose tolerance test, gestational diabetes is diagnosed when two or more of the four plasma glucose values (fasting, 1-hour, 2-hour, 3-hour) meet or exceed the established thresholds. A single elevated value does not confirm the diagnosis.
Question 2 of 5
A client with gestational diabetes asks about the recommended first-line management. Which statement reflects the standard initial approach the nurse should reinforce?
Answer: B. Medical nutrition therapy combined with moderate exercise and blood glucose self-monitoring is the first-line management for gestational diabetes. Pharmacologic therapy (insulin is the preferred agent) is added only when glucose targets are not met with diet and activity.
Question 3 of 5
A pregnant client with gestational diabetes is taught fasting and postprandial glucose goals. Which fasting blood glucose value indicates that her control meets the recommended target?
Answer: A. For gestational diabetes, the commonly used fasting blood glucose target is less than 95 mg/dL. A fasting value of 90 mg/dL is within goal. Values of 95 mg/dL or higher fasting suggest inadequate control and may warrant therapy adjustment.
Question 4 of 5
A nurse measures the fundal height of a client and finds it equals the distance in centimeters from the symphysis pubis to the top of the fundus. At approximately which gestational age does the fundal height in centimeters roughly equal the number of weeks?
Answer: B. From about 20 weeks to 36 weeks gestation, fundal height in centimeters approximately equals the number of weeks of gestation (plus or minus 2 cm). A measurement markedly different from gestational age may indicate growth restriction, multiple gestation, or polyhydramnios.
Question 5 of 5
A client with gestational diabetes reports shakiness, sweating, and palpitations 2 hours after her insulin dose. What is the nurse's first action?
Answer: B. These are classic signs of hypoglycemia. If the client is alert and able to swallow, the priority is to give 15 grams of a fast-acting oral carbohydrate (such as 4 oz of juice), then recheck the glucose in 15 minutes. Notifying the provider or giving more insulin is not the first step.
Keep the streak going with more questions like these, each with a full rationale.
What is gestational diabetes?
It typically appears in the second or third trimester and usually resolves after delivery. It matters because uncontrolled maternal hyperglycemia leads to a macrosomic infant, birth trauma, and neonatal hypoglycemia after birth.
Key points to remember
- Placental hormones create insulin resistance, so maternal blood glucose rises, especially after meals.
- Excess maternal glucose crosses the placenta and stimulates fetal insulin, producing macrosomia (large infant).
- After birth the high fetal insulin level persists briefly, causing neonatal hypoglycemia.
- Maternal complications include preeclampsia, polyhydramnios, and an increased rate of cesarean birth.
- Screening is done with a 1-hour 50 g glucose challenge, confirmed by a 3-hour 100 g oral glucose tolerance test, usually at 24-28 weeks.
- Women with GDM have a higher lifetime risk of developing type 2 diabetes.
Nursing priorities
- Teach and reinforce a controlled-carbohydrate diet and regular physical activity as first-line management.
- Instruct on home blood glucose self-monitoring (fasting and postprandial values) and recording results.
- Administer insulin as prescribed when diet and exercise do not control glucose (insulin is the preferred drug in pregnancy).
- Monitor fetal growth and well-being with ultrasound and nonstress tests as ordered.
- After delivery, monitor the newborn closely for hypoglycemia and feed early.
Labs & values
Patient teaching
- Check and log blood glucose at the times your provider specifies, and bring records to each visit.
- Follow the prescribed meal plan with consistent carbohydrate amounts and avoid concentrated sugars.
- Get tested for type 2 diabetes after the postpartum period because GDM raises your future risk.
Red flags: report now
- Report fasting glucose consistently above 95 mg/dL or postprandial values above target, indicating poor control.
- Report signs of macrosomia or polyhydramnios, which raise the risk of shoulder dystocia and birth injury.
- Assess the newborn for jitteriness, poor feeding, or lethargy, which signal neonatal hypoglycemia requiring immediate feeding or glucose.
References
Clinical references for this topic
