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According to Osgood, Dyck, and Grassman (2011), gestational diabetes results from insulin resistance and relative insulin deficiency that comes with pregnancy. Pregnancy is usually a diabetogenic state when sensitivity to insulin lessens with advancing gestational age (Clapperton, Jarvis & Mungrue, 2009). The World Health Organization (2008) defines gestational diabetes as a carbohydrate intolerance, which leads to hyperglycemia of varying severity with the start of first recognition during pregnancy. According to Clapperton et al (2009), this may also arise due to previously undetected pregestational diabetes mellitus or true diabetes mellitus: this is type 2 diabetes mellitus which fails to be detected before and independent of the pregnancy. The hormones, which influence causal fetus growth and development, usually mobilize the nutritional resources of the woman, mainly glucose, and avail them to the fetus (Rubin & Ramsey, 2008). During the last twenty gestation weeks, plasma levels of the critical anabolic hormones usually increase dramatically. An increased mobilization of glucose together with reduced insulin sensitivity usually place women at risk of developing diabetes while pregnant, nevertheless not all women develop gestational diabetes (Gabbe, Niebyl & Simpson et al. 2012; Metzger, Lowe & Dyer, 2008).
According to Sullivan, Umans, and Ratner (2011), gestational diabetes affect about 5% to 14% of all pregnant women in U.S. and about 35% to 60% of women who have previously had diabetes mellitus, get diabetes mellitus within ten tears of index pregnancy. The American Diabetes Association (2009) notes that gestational diabetes occur in approximately 14% of all pregnancies and result in about 200,000 cases yearly in the US. As the occurrence of type-2 diabetes mellitus has increased over the last few decades, an escalation in the cases of gestational diabetes has also been noted. The prevalence of gestational diabetes doubled between 1994 and 2002, and this rise is attributed to better diagnostic and screening tools and the increasing obesity rates in the US (Thacker & Petkewicz, 2009). Sedentary lifestyles as well as excess calorie intake are the main causal factors leading to obesity. Gestational diabetes comprises 90% of all pregnancy complications, which is resulted from diabetes mellitus (Harlev & Wiznitzer, 2010).
Insulin resistance is a damaged reaction to insulin, which characterizes most of the pregnancies. This resistance usually results from an increased insulin secretion in the pancreatic β cells (Harlev & Wiznitzer, 2010). Reece, Leguizamon, and Wiznitzer (2009) argue that gestational diabetes causes a failure to boost insulin creation to recompense for the rise in insulin resistance. Insulin deficiency and insulin resistance resulting from deterioration of the pancreatic β-cell are the main metabolic alterations in gestational diabetes (Megia, Vendrell & Gutierrez et al. 2008). A further reduction of β-cell function makes hyperglycemia more severe (Xiang, Kawakubo & Trigo, 2010). According to Harlev and Wiznitzer (2010), an individual may lose 40% of β-cells. Gluconeogenesis also increases because of insulin resistance as well as the occurring insulin deficit. It causes the hyperglycemia to become worse. Wiznitzer, Mayer, and Novack et al (2009) discovered that increased triglycerides levels are related to an increased risk of GDM during pregnancy.
Demographics of Gestational Diabetes
Gestational diabetes usually affects about 5% to 14% of all pregnant women in US however, certain subgroups of women are at much higher risk. It occurs more frequently among Hispanic/Latino Americans, African Americans, and American Indians (National Diabetes Information Clearinghouse (NDIC), 2011). It is also more common among women who are obese and those with a family history of diabetes. Diabetes is also common among pregnant women who are at advanced age and those who smoke (Hunt & Schuller, 2007). Gestational diabetes also occurs more frequently among women from lower socioeconomic. Gestational diabetes prevalence at the Kaiser Foundation Hospital was recorded to be “highest among black (7.5%) and Hispanic (6.3%) women, and lower in non-Hispanic whites (4.9%), Asians (4.7%), and Filipinos (3.6%)” (Coustan, n.d., p. 709).
Nutrition during Pregnancy
Glucose intolerance during pregnancy usually leads to high blood pressure/hyperglycemia. As a result, good nutrition, such as controlling the calorie and carbohydrates intake, is important in controlling the blood glucose levels (Cox & Phelan, 2008; Chasan-Taber, 2012). Nevertheless, there is need to do this while ensuring enough nutrition without too much weight gain. Women with gestational diabetes are also advised to maintain their blood sugar within a reasonable range with mild restriction of their dietary carbohydrates (Sharlin & Edelstein, 2011; Vambergue & Fajardy, 2011). The diet should match age and weight goals of the pregnant woman. The typical diet should include 30-35 kcal/kg and the pregnant women should maintain an intake of polyunsaturated fats: they should be 10% of total fat or less. Generally, the food taken should lower the glucose level to a normoglycemic level to avoid complications (Escott-Stump, 2008; Brown, 2008).
Physical Activity during Pregnancy
Physical activity checks excessive weight gain, and this helps to lessen gestational diabetes occurrence and other conditions such as hypertension (Barakat, Cordero & Coteron et al 2012; Stuebe & Gillman, 2009; Harizopoulou, Kritikos, & Papanikolaou, 2010). Evidence-based guidelines show that regular prenatal exercise is an imperative element of a healthy pregnancy. Walking is effective in preventing excessive weight gain in pregnant overweight. Tobias, Zhang, and van Dam (2011) found that higher physical activity levels in early pregnancy and before pregnancy lead to considerably lower risks of developing gestational diabetes. Since body muscles require glucose for energy, physical activity provides a natural way of reducing excess glucose from the blood. A modest physical activity plan during pregnancy boosts tolerance of maternal glucose (Barakat et al. 2012). Also, physical activities reduce important gestational diabetes-related adverse outcomes (Barakat, Pelaez & Lopez, 2013; Redden, LaMonte & Freudenheim, 2011).
PowerPoint presentations are important interactive methods of educating pregnant women on gestational diabetes issues. They combine both visual and audio aspects, making it easier for the audience to understand (Deven, Hibbert, & Chhem, 2010). PowerPoint has the capacity to convey ideas and support the speakers’ remarks in a concise manner. Sounds, animations, and other effects can be used to lay emphasis on major point to enrich the presentation (Lowenstein, Foord & Romano, 2009). It enhances the teaching and learning experience. The most important aspects of a good presentation are the teaching skills: organization, choice of content, oral presentation skills and delivery and visual enhancement (Deven et al, 2010). As a result, there is need to consider the content being taught on gestational diabetes and the teaching skills in order to effectively use and make the most of the PowerPoint Presentation.
The most appropriate adult learning theory to deliver gestational information to the rural, poor pregnant women diagnosed with gestational diabetes is behavioral learning theory where learning is evidenced by behavior change. Gestational diabetes related adverse outcomes can be reduced or eliminated through encouraging women to control their calorie and carbohydrates intake and also take part in physical activity. It calls for a change in behavior. Behaviorism operant condition focuses on the environmental factors, which influence the types of behaviors that people exhibit, and the extent to which they are likely to exhibit them in the future (Snowman & McCowan, 2012). Pleasant and unpleasant consequences should be used to control unhealthy behaviors: operant conditioning. In behavioral learning theory, new skills are shaped or taught through a series of reinforcing steps towards the desired final action (Schunk, 2008).
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