Nursing Care Plans for Gestational Diabetes Mellitus – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Gestational Diabetes Mellitus plus its causes, symptoms, preventions, treatments and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.


Gestational diabetes mellitus (GDM) is a condition in which a hormone made by the placenta prevents the body from using insulin effectively. Glucose builds up in the blood instead of being absorbed by the cells.

Unlike type 1 diabetes, gestational diabetes is not caused by a lack of insulin but by other hormones produced during pregnancy that can make insulin less effective, a condition referred to as insulin resistance. Gestational diabetic symptoms disappear following delivery.

Approximately 3 to 8 percent of all pregnant women in the United States are diagnosed with gestational diabetes.

Causes Gestational Diabetes Mellitus

Although the cause of GDM is not known, there are some theories as to why the condition occurs.

The placenta supplies a growing fetus with nutrients and water and produces various hormones to maintain the pregnancy. Some of these hormones (estrogen, cortisol, and human placental lactogen) can block insulin. This is called the contra-insulin effect, which usually begins about 20 to 24 weeks into the pregnancy.

As the placenta grows, more of these hormones are produced, and the risk of insulin resistance becomes more significant. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.

Risks Factors of Gestational Diabetes Mellitus

Although any woman can develop GDM during pregnancy, some of the factors that may increase the risk include the following:

  • Overweight or obesity
  • Family history of diabetes
  • Having given birth previously to an infant weighing greater than 9 pounds
  • Age (women who are older than 25 are at a greater risk for developing gestational diabetes than younger women)
  • Race (women who are African-American, American Indian, Asian American, Hispanic or Latino, or Pacific Islander have a higher risk)
  • Prediabetes, also known as impaired glucose tolerance
  • Although increased glucose in the urine is often included in the list of risk factors, it is not believed to be a reliable indicator for GDM.

Diagnosis of Gestational Diabetes Mellitus

The American Diabetes Association recommends screening for undiagnosed type 2 diabetes at the first prenatal visit in women with diabetes risk factors. In pregnant women not known to have diabetes, GDM testing should be performed at 24 to 28 weeks of gestation.

In addition, women with diagnosed GDM should be screened for persistent diabetes 6 to 12 weeks postpartum. It is also recommended that women with a history of GDM undergo lifelong screening for the development of diabetes or prediabetes at least every three years.

Treatment for Gestational Diabetes Mellitus

Specific treatment for gestational diabetes will be determined by your doctor based on:

  • Age, overall health, and medical history
  • The extent of the disease
  • Tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease

Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:

  1. Special diet
  2. Exercise
  3. Daily blood glucose monitoring
  4. Insulin injections

Possible complications for the baby

Unlike type 1 diabetes, gestational diabetes generally occurs too late to cause birth defects. Birth defects usually originate sometime during the first trimester (before the 13th week) of pregnancy. The insulin resistance from the contra-insulin hormones produced by the placenta does not usually occur until approximately the 24th week. Women with gestational diabetes mellitus generally have normal blood sugar levels during the critical first trimester.

The complications of GDM are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of diabetes is made.

Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum magnesium levels, but, in general, there are two major problems of gestational diabetes: macrosomia and hypoglycemia:


Macrosomia refers to a baby who is considerably larger than normal. All of the nutrients the fetus receives come directly from the mother’s blood. If the maternal blood has too much glucose, the pancreas of the fetus senses the high glucose levels and produces more insulin in an attempt to use this glucose. The fetus converts the extra glucose to fat. Even when the mother has gestational diabetes, the fetus is able to produce all the insulin it needs. The combination of high blood glucose levels from the mother and high insulin levels in the fetus results in large fat deposits, which causes the fetus to grow excessively large.


Hypoglycemia refers to low blood sugar in the baby immediately after delivery. This problem occurs if the mother’s blood sugar levels have been consistently high, causing the fetus to have a high insulin level in its circulation. After delivery, the baby continues to have a high insulin level, but it no longer has the high level of sugar from its mother, resulting in the newborn’s blood sugar level becoming very low. The baby’s blood sugar level is checked after birth, and if the level is too low, it may be necessary to give the baby glucose intravenously.

Blood glucose is monitored very closely during labor. Insulin may be given to keep the mother’s blood sugar normal to prevent the baby’s blood sugar from dropping excessively after delivery.

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Nursing care plans for gestational diabetes mellitus
Nursing Care Plans for Gestational Diabetes Mellitus

Nursing Care Plans for Gestational Diabetes Mellitus Based on Diagnosis

Nursing Care Plan 1: Diagnosis – Risk for Maternal Injury

Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

Risk factors

  • Altered immune response.
  • Anemia.
  • Changes in diabetic control.
  • Tissue hypoxia.

Desired Outcomes

  • A patient will be free of signs and symptoms of diabetic ketoacidosis (fruity-scented breath, excessive thirst, frequent urination, weakness, confusion).
  • A patient will remain normotensive.
  • A patient will maintain normoglycemia.
Nursing InterventionsRationale
Assess client for vaginal bleeding and abdominal tenderness.Vascular changes associated with diabetes place the client at risk for abruption placenta.
Determine the nature of any vaginal discharge.If glycosuria is present, a client is more likely to develop monilial vulvovaginitis, which is caused by Candida albicans and may lead to oral thrush in newborns.
Assess for any signs and symptoms of UTI.Early detection of UTI may prevent the occurrence of pyelonephritis, which can contribute to premature labor.
Assess and monitor for signs of edema.Because of vascular changes, the diabetic client is prone to excess fluid retention and PIH. The severity of the vascular changes prior to pregnancy influences the extent and time of onset of PIH.
Determine fundal height; check for edema of extremities and dyspnea.Hydramnios occurs in 6%-25% of pregnant diabetic clients. May be associated with an increased fetal contribution to amniotic fluid because hyperglycemia increases fetal urine output.
Identify episodes of hyperglycemia.Diet and/or insulin regulation is necessary for normoglycemia, especially in second and third trimesters, when insulin requirements usually doubled.
Identify episodes of hypoglycemia.Hypoglycemic episodes occur most frequently in the first trimester, owing to continuous fetal drain on serum glucose and amino acids and to low levels of HPL. In the presence of hypoglycemia, vomiting may lead to ketosis.
Monitor for signs and symptoms of pre-term labor. Hydramnios may predispose the client to early labor.Overdistention of the uterus is caused by macrosomia.
Note White’s classification for diabetes. Assess the degree of diabetic control (Pederson’s Criteria).Client classified as D, E, or F is at high risk for complications, as is a client with PBSP.
Assist client in learning home monitoring of blood glucose, to be done a minimum of 4 times/day.Allows greater accuracy than urine testing because the renal threshold for glucose is lowered during pregnancy. Facilitates tighter control of serum glucose levels.
Request that client check urine for ketones daily.Ketonuria indicates a presence of a starvation state, which may negatively affect the developing fetus.
Monitor client closely if tocolytic drugs are used to arrest labor.Tocolytic drugs may increase serum blood glucose and insulin levels.
Monitor serum glucose level each visit.Detects impending ketoacidosis; helps determine times of day during which client is prone to hypoglycemia.
Monitor Hematocrit and hemoglobin levels on the initial visit, then during the second trimester and at term.Anemia may be present in a client with vascular involvement.
Obtain HbA1c every 2-4 weeks, as indicated.Allows accurate assessment of glucose control for the past 60 days.
Monitor for total protein excretion, creatinine clearance, BUN, and uric acid levels.Progressive vascular changes may impair renal function in severe or long-standing diabetes clients.
Obtain urinalysis and urine culture; administer antibiotics as indicated.Helps prevent or treat pyelonephritis. Note: Some antibiotics might be contraindicated because of the danger of teratogenic effects.
Obtain culture of vaginal discharge, if present.Candida vulvovaginitis can cause oral thrush in the newborn.
Prepare client for ultrasonography at 8, 12, 18, 26, and 36-38 weeks of gestation as indicated.Determines fetal size using the biparietal diameter, femur length, and estimated fetal weight. The client is at risk for CPD and dystocia due to macrosomia.
Scheduled for ophthalmologic examination during the first trimester for all clients, and in second and third trimesters if clients are at class D, E, F.Owing to several vascular involvements, background retinopathy may progress during pregnancy. Laser coagulation therapy may improve the client’s condition and reduce optic fibrosis.
Start IV therapy with 5% dextrose; administer glucagon SC if a client is hospitalized with insulin shock and is unconscious. Follow with protein-containing foods/fluids, e.g., 15 grams of beans.Glucagon is a naturally occurring substance that acts on liver glycogen and converts it to glucose, which corrects the hypoglycemic state. (Note: Hypertonic Glucose D50 administered IV may have negative effects on fetal brain tissue because of its hypertonic action). Protein helps sustain normoglycemia over a longer period.

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Nursing care plans for gestational diabetes mellitus
Nursing Care Plans for Gestational Diabetes Mellitus

Nursing Care Plan 2: Diagnosis – Risk for Fetal Injury

Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

Risk factors

  • Changes in circulation.
  • Elevated maternal serum blood glucose levels.

Desired Outcomes

A fetus will normally display reactive normal stress test and negative OCT and CST.

Nursing InterventionsRationale
Determine White’s classification for diabetes; explain classification and significance to client/couple.A fetus is at less risk if White’s classification is A, B, or C. The client with classification DD, E, or F who develops kidney or acidotic problems or PIH is at high risk. As a means of determining prognosis for a perinatal outcome, White’s classification has been used in conjunction with (1) evaluation of diabetic control or lack of control and (2) presence or absence of Pedersen’s prognostically bad signs of pregnancy (PBSP), which includes acidosis, mild/severe toxemia, and pyelonephritis. The National Diabetes Data Group Classification, which includes diabetes mellitus (type I, insulin-dependent; type II, noninsulin-dependent), impaired glucose tolerance, and gestational diabetes mellitus, has not yet had prognostic significance in predicting perinatal outcomes.
Determine client’s diabetic control before conception.Strict control (normal HbA1c levels) before conception helps reduce the risk of fetal mortality and congenital abnormalities.
Monitor for signs of PIH (edema, hypertension, proteinuria).About 12-13% of diabetic individuals develop hypertensive disorders owing to cardiovascular changes associated with diabetes. These disorders negatively affect placental perfusion and fetal status.
Monitor fundal height each visit.Useful in identifying abnormal growth patterns (macrosomia or IUGR, small or large gestational age [SGA/LGA]).
Assess fetal movement and fetal heart rate each visit as indicated. Encourage the client to periodically record fetal movements at about 18 weeks gestation, then daily from 34 weeks gestation.Fetal movement and fetal heart rate may be negatively affected when placental insufficiency and maternal ketosis occur.
Monitor urine for ketones. Note for fruity breath.Irreparable CNS damage or fetal death can occur as a result of maternal ketonemia, especially in the third trimester.
Provide information about the possible effects of diabetes on fetal growth and development.It helps the client to make informed decisions about managing regimens and may increase cooperation.
Provide information and reinforce procedures for home blood glucose monitoring and diabetic management.Decreased fetal or newborn mortality and morbidity complications and congenital anomalies are associated with optimal FBS levels between 70 to 96 mg/dL and 2-hr postprandial glucose level of less than 120 mg/dL. Frequent monitoring is important to maintain this tight range and to reduce the incidence of fetal hypoglycemia or hyperglycemia.
Discuss rationale/procedure for carrying out periodic Oxytocin Challenge Test (OCT) or Contraction Stress Test (CST) beginning at 30-32 weeks’ gestation, depending on the diagnosis of NIDDM or GDM.CST assesses placental perfusion of oxygen and nutrients to the fetus. Positive results indicate placental insufficiency, in which case the fetus may need to be delivered surgically.
Review rationale and procedure for periodic NSTs (e.g., weekly NST after  30 weeks gestation, twice-weekly NST after 36 weeks gestation).Fetal activity and movement are good predictors of fetal wellness. Activity level decreases before alterations in FHR occur.
Review rationale and procedure for amniocentesis using lecithin-sphingomyelin ratio (L/S) ratio and the presence of phosphatidylglycerol (PG).When there is impaired maternal/placental functioning before term, fetal lung maturity is a criterion used to determine whether survival is possible. Hyperinsulinemia inhibits and interferes with surfactant production; therefore, in the diabetic client, testing for the presence of PG is more accurate than using the L/S ratio.
Assess glycosylated albumin level at 24-28 weeks’ gestation, especially for a client in a high-risk category (history of macrosomic infants, previous GDM, or positive family history of GDM). Follow with oral glucose tolerance test (OGTT) if test results are positive.Serum test for glycosylated albumin reflects glycemia over several days and may gain acceptance as a screening tool in determining GDM because it does not involve potentially harmful glucose loading as does with OGTT.
Assess HbA1c every 2-4 weeks, as indicated.Incidence of congenitally malformed infants is increased in women with high HbA1c levels (greater than 8.5%) early in pregnancy or before conception. Note: HbA1c is not sensitive enough as a screening tool for GDM.
Obtain sequential serum or 24-hr urinary specimen for estriol levels after 30 weeks gestation.Although estriol levels are not used as often now, falling levels may indicate decreased placental functioning, leading to a possibility of intrauterine growth restriction (IUGR) and stillbirth.
Verify Alpha-fetoprotein (AFP) levels are obtained at 14-16 weeks’ gestation.Although AFP screen is recommended for all clients, it is especially important in this population because neural tube defects are greater in diabetic clients than in nondiabetic clients, particularly if poor control existed before pregnancy.
Review periodic creatinine clearance levels.There is a slight parallel between renal vascular damage and impaired uterine blood flow.
Perform Nonstress test (NST) and Oxytocin Challenge Test (OCT)/Contraction Stress Test (CST), as appropriate.Assesses fetal well-being and adequacy of placental perfusion.
As indicated, prepare for ultrasonography at 8, 12, 18, 28, and 36-38 weeks’ gestation.Ultrasonography is useful in confirming gestation date and helps to evaluate intrauterine growth restriction (IUGR).
Assist as necessary with biophysical profile (BPP) assessment.Provides a score to assess fetal well-being/risk, The criteria include NST results, fetal breathing movements, amniotic fluid volume, fetal tone, and fetal body movements. For each criterion met, a score of 2 is given. A total score of 8-10 is reassuring, a score of 4-7 indicates a need for further evaluation and retesting, and a score of 0-3 is ominous.
Assist with preparation for delivery of fetus vaginally or surgically if test results indicate placental aging and insufficiency.Helps ensure a positive outcome for the neonate. The incidence of stillbirths increases significantly with gestation of more than 36 weeks. Macrosomia often causes dystocia with cephalopelvic disproportion (CPD).

Nursing Care Plan 3: Diagnosis – Risk for Altered Nutrition: Less than Body Requirements

Risk for Altered Nutrition: Less Than Body Requirements: At risk for an insufficient intake of nutrients to meet metabolic needs.

Risk factors

  • Inability to utilize nutrients appropriately.

Desired Outcomes

  • A patient will verbalize understanding of the individual treatment regimen and the need for frequent self-monitoring.
  • A patient will maintain fasting serum blood glucose levels between 60-100 mg/dl and 1-hour postprandial of no higher than 140 mg/dl.
  • A patient will gain at least 24-30 lbs prenatally or as appropriate for pre-pregnancy weight.
  • A patient will be free of signs and symptoms of diabetic ketoacidosis (fruity-scented breath, excessive thirst, frequent urination, weakness, confusion).
Nursing InterventionsRationale
Assess and record dietary patterns and caloric intake using a 24-hour recall.To help in evaluating the client’s understanding and/or compliance to a strict dietary regimen.
Assess understanding of the effect of stress on diabetes. Teach the patient about stress management and relaxation measures.It is proven that stress can increase serum blood glucose levels, creating variations in insulin requirements.
Weigh the client every prenatal visit. Encourage the client to monitor weight at home between visits periodically.Weight gain serves as an indicator for determining caloric adjustments.
Observe for the presence of nausea and vomiting, especially during the first trimester.Nausea and vomiting may be brought about by a deficiency in carbohydrates, which may result in the metabolism of fats and the development of ketosis.
Teach the importance of regularity of meals and snacks (e.g., three meals or 4 snacks) when taking insulin.Eating very frequent small meals improves insulin function.
Teach and demonstrate client to monitor sugar using a finger-stick method.Insulin needs for the day can be adjusted based on periodic serum glucose readings. Note: Values obtained by reflectance meters maybe 10-15% lower/higher than plasma levels.
Provide information regarding any required changes in diabetic management; e.g., use of human insulin only, changing from oral diabetic drugs to insulin, self-monitoring of serum blood glucose levels at least twice a day (e.g., before breakfast and before dinner), and reducing/changing time for ingesting carbohydrates.Metabolism and maternal/fetal needs fluctuate during the gestation period, requiring close monitoring and adaptation. Research suggests antibodies against insulin may cross the placenta, causing inappropriate fetal weight gain. The use of human insulin decreased the development of these antibodies. Reducing carbohydrates to less than 40% of the calories ingested reduces the degree of a postprandial peak of hyperglycemia. Because pregnancy provides severe morning glucose intolerance, the first meal of the day should be small, with minimal carbohydrates.
Provide information regarding the signs, symptoms, and hyperglycemia or hypoglycemia differences.Hypoglycemia may be more sudden or severe during the first trimester, owing to an increased usage of glucose and glycogen by a client and developing fetus, as well as low levels of the insulin antagonist human placental lactogen (HPL). Ketoacidosis occurs more frequently during the second and third trimesters because of the resistance to insulin and elevated HPL levels. Sustained or intermittent pulse of hyperglycemia re mutagenic and teratogenic for the fetus in the first trimester; may also cause fetal hyperinsulinemia, macrosomia, inhibition of lung maturity, cardiac dysrhythmia, neonatal hypoglycemia, and risk of permanent neurologic damage. Maternal effects of hyperglycemia can include hydramnios, vaginal and urinary tract infections, hypertension, and spontaneous termination of pregnancy.
Recommend monitoring urine ketones on awakening and when a planned meal or snack is delayed.Insufficient caloric intake is reflected by ketonuria, indicating a need for an increased intake of carbohydrates or additional snacks in the dietary plan (e.g., recurrent presence of ketonuria on awakening may be eliminated by 3 am a glass of milk). The presence of ketones during the second trimester may reflect “accelerated starvation” as the diminished effectiveness of insulin results in a catabolic state during fasting periods (e.g., skipping meals), causing maternal metabolism of fat. Adjustment of insulin type, dosage, and/or frequency must be required.
Instruct client to treat symptomatic hypoglycemia, if it occurs, with an 8-oz glass of milk and to repeat in 15 minutes if serum glucose levels remain below 70 mg/dl.Using plenty of simple carbohydrates to treat hypoglycemia causes serum glucose values to elevate. A combination of complex carbohydrates and protein maintains normoglycemia longer and helps maintain the stability of serum glucose throughout the day.
Discuss the type of insulin, dosage and schedule (e.g., usually 4 times/day: 7:30am-NPH; 10am-regular; 4pm-NPH; 6pm-regular).Division of insulin dosage considers basal maternal needs and mealtime insulin-to-food ratio and allows more freedom in meal-scheduling. Total daily dosage is based on gestational, current maternal body weight, and serum glucose levels. A mix of NPH and regular human insulin helps mimic the normal insulin release pattern of the pancreas, minimizing the “peak/valley” effect of serum glucose level. Note: Although some providers may choose to manage clients with GDM with oral hypoglycemic agents, insulin is still the drug of choice.
Adjust diet or insulin regimen to meet individual needs.Prenatal metabolic needs change throughout the trimesters, and adjustment is determined by weight gain and laboratory test results. Insulin needs in the first trimester are 0.7 units/kg of body weight. Between 18-24 weeks of gestation, it increases to 0.8 unit/kg; at 34 weeks gestation, 0.9 unit/kg, and 1.0 unit/kg by 36 weeks gestation.
Monitor serum blood glucose levels (fasting blood sugar, preprandial 1 and two hr postprandial) on the first visit, then as indicated by the client’s condition.Incidence of fetal and newborn abnormalities is decreased when fasting blood sugar levels range between 60 and 100 mg/dl, preprandial levels between 60 and 105 mg/dl, 1-hr postprandial remains below 140 mg/dl, and 2-hr postprandial is less than 120 mg/dl.
Ascertain results of HbA1c every 2-4weeks.Provide an accurate picture of average serum glucose control during the preceding 60 days. Serum glucose control takes six weeks to normalize.
Coordinate multispecialty care conferences as appropriate.Provides an opportunity to review the management of both pregnancy and diabetic conditions and to plan for special needs during intrapartum and postpartum periods.
Refer to a registered dietician to individualize diet and counsel regarding dietary questions.Diet specific to the individual is necessary to maintain normoglycemia and to obtain desired weight gain. In-depth teaching promotes understanding of own needs and clarifies misconceptions, especially for a client with gestational diabetes. Note: New recommendations set dietary needs at 255 kcal/kg depending on the client’s current pregnant weight.
Prepare for hospitalization if diabetes is not controlled.Infant morbidity is linked to maternal hyperglycemia-induced fetal hyperinsulinemia.

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Nursing care plans for gestational diabetes mellitus
Nursing Care Plans for Gestational Diabetes Mellitus

Related FAQs

1. What are the nursing diagnosis for gestational diabetes?

Nursing Diagnosis: Risk for Imbalanced Nutrition: Less than Body Requirements related to lack of ability to make use of nutrients appropriately secondary to gestational diabetes. Desired Outcomes: The patient will express an understanding of the treatment management process and the necessity of regular self-assessment.

2. What is the nursing management of gestational diabetes mellitus?

Management of GDM includes weight management, MNT, SMBG levels, exercise, and if necessary, medication if glucose targets are not met. It is imperative that women gain the appropriate amount of weight during pregnancy to prevent excessive pregnancy weight gain and postpartum weight retention.

3. What should a diabetes care plan include?

  • Treatment goals. Treatment goals are at the center of a diabetes type 2 care plan, because they dictate what the care plan must include. …
  • Blood glucose monitoring. …
  • Treatment for high or low blood sugar. …
  • Details of insulin therapy. …
  • Diet and exercise.

4. How do you monitor a patient with gestational diabetes?

Initial glucose challenge test.

You’ll drink a syrupy glucose solution. One hour later, you’ll have a blood test to measure your blood sugar level. A blood sugar level of 190 milligrams per deciliter (mg/dL), or 10.6 millimoles per liter (mmol/L), indicates gestational diabetes.

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