Diabetes in pregnancy: screening tests, glucose self-monitoring, education and the birth
- Safe practice
The nurse makes sure the glucose test is done, teaches the woman to check and record her glucose, eat well and move, and prepares the newborn's glucose checks.
What it is
Gestational diabetes appears in pregnancy when the body cannot make enough insulin for the extra needs. It often causes no symptoms, so it is found by testing. Women who had diabetes before pregnancy (type 1 or 2) are high risk from the start. Nursing care is mostly teaching: glucose self-monitoring, healthy eating, physical activity and, when prescribed, the medicine. It also prepares the birth, because the baby can be large and can have low blood glucose after birth.
What it requires
- Risk factors: gestational diabetes in a previous pregnancy, a previous baby over 9 pounds (about 4 kg), overweight, family history of type 2 diabetes, polycystic ovary syndrome, some ethnic groups.
- Type 1 or type 2 diabetes is a high-risk criterion for preeclampsia in Res. 3280.
- A pregnant woman should not try to lose weight: some weight gain is needed for the baby.
- Babies tend to be larger, which raises the risk of birth injury and caesarean.
Components
- Glucose meter, test strips, lancets and a logbook.
- The food plan agreed with nutrition and an activity plan.
- The medicine and supplies the physician prescribes, if any.
How it is applied (and why)
- Check that the glucose tolerance test was done in weeks 24 to 28, or earlier if she is at risk — the disease is often silent.
- Teach self-monitoring: prick a finger, place the drop of blood on the meter and read it — reliable values guide treatment.
- Agree with the team on the times to check and teach her to record every value — the team adjusts the plan with the log.
- Reinforce healthy eating: moderate fat and protein, complex carbohydrates with fruit and vegetables, few sugary foods — lowers glucose.
- Encourage low-impact activity such as brisk walking or swimming — it lowers glucose and improves insulin sensitivity.
- If insulin or another medicine is prescribed, teach the technique, storage and signs of low glucose per protocol — doses are set by the team.
- Explain the extra fetal checks, such as the non-stress test — monitoring increases near term when she takes medicine.
- Tell the newborn team about the diabetes and plan early breastfeeding — the baby is at risk of low glucose.
- Before discharge, explain the follow-up for type 2 diabetes in the years after birth — half develop it.
In nursing practice
- The newborn of a mother with diabetes is dried thoroughly, assessed at least every 8 hours and watched closely for low glucose and breathing problems.
- If the newborn adapts well and the glucose checks are normal, discharge can be after 48 hours of hospital observation.
- Babies may have low blood glucose in the first days and may need care in a neonatal intensive care unit.
- Blood glucose often returns to normal after birth, but the woman needs follow-up for diabetes for 5 to 10 years.
Common mistakes
- Not recording the glucose values, or recording them from memory.
- Advising a weight-loss diet in pregnancy.
- Forgetting to tell the newborn team, so the 2- and 4-hour glucose checks are missed.
- Not arranging follow-up for type 2 diabetes after birth.
Test yourself
Think of the answer, then tap the question to see it.
When is the oral glucose tolerance test done in Colombian prenatal care?
Between weeks 24 and 28 of pregnancy (Res. 3280 de 2018); earlier if the woman is at higher risk.
At what ages are glucose checks done in the newborn of a mother with diabetes?
At 2 and 4 hours of life, and then according to the first results.
Should a woman with gestational diabetes try to lose weight during pregnancy?
No. Some weight gain is needed for the baby; she follows the food plan and stays active.
Why does a woman with gestational diabetes need follow-up after birth?
Because about half later develop type 2 diabetes.
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Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018); Gestational Diabetes (Centers for Disease Control and Prevention, 2024); Gestational diabetes (MedlinePlus, U.S. National Library of Medicine, 2026).
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