A nurse is evaluating the outcomes of care for a pregnant woman who has gestational diabetes and received insulin therapy during pregnancy.

Which of the following findings indicates that the insulin therapy was effective?

The correct answer is choice B. The woman delivered a healthy baby who weighed 3 kg (6.6 lb) at birth.This indicates that the insulin therapy was effective in preventing macrosomia, which is a common complication of gestational diabetes mellitus (GDM).Macrosomia is defined as a birth weight above the 90th percentile for gestational age or above 4 kg (8.8 lb).Macrosomia increases the risk of birth trauma, shoulder dystocia, cesarean section, and neonatal hypoglycemia.

Choice A is wrong because normal blood pressure and urine protein levels throughout pregnancy are not specific indicators of insulin therapy effectiveness.They are more related to the prevention of pre-eclampsia, which is a separate complication of pregnancy that can affect women with or without GDM.

Choice C is wrong because having no episodes of hypoglycemia or hyperglycemia during pregnancy is not sufficient to indicate insulin therapy

The correct answer is choice A. The nurse should monitor the woman’s blood glucose levels every hour during labor.This is because maternal blood glucose levels around the time of delivery are directly related to the risk of neonatal hypoglycemia.Therefore, achieving maternal euglycemia in women with gestational diabetes mellitus is critical to decreasing the risk of neonatal complications.

Choice B is wrong because every two hours is not frequent enough to ensure optimal glucose control during labor.

Choice C is wrong because every four hours is even less frequent and may miss significant fluctuations in blood glucose levels.

Choice D is wrong because every six hours is too infrequent and may put the mother and the baby at risk of adverse outcomes.

The maternal glucose should be maintained between 4.0 and 6.0-7.0 mmol/L during labor.Most women with gestational diabetes, especially if they require less than 1.0 units/kg/d of insulin, can simply be monitored without intravenous insulin.However, women who are taking medication for gestational diabetes require more frequent glucose monitoring, typically with hourly evaluations.