GDM and Postpartum Followup – The ‘When and How’ of Screening
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Explain the post partum screening protocols used to diagnose diabetes 2. Define the plasma glucose values necessary to diagnose prediabetes and diabetes
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
While there is controversy as to how best to screen for gestational diabetes mellitus (GDM) during pregnancy, all professional groups recommend screening during the postpartum period following GDM for prediabetes or diabetes at 4 to 12 weeks postpartum. Historically, two options, fasting plasma glucose (FPG) and the 2 hour oral glucose tolerance test (OGTT) have been used. However, ACOG, citing the Fifth International Workshop on Gestational Diabetes recommends the 2 hour OGTT, which should include FPG as well, to improve sensitivity:
Up to 1/3 of women who had GDM during their pregnancy will have impaired glucose metabolism or diabetes at postpartum screening and up to 70% may develop diabetes later in life. Even if screening is negative at the postpartum visit, the ADA and ACOG recommended assessing glycemic status every 1 to 3 years and counseling patients regarding diet and/or exercise as needed. Follow up screening is particularly advantageous for those women considering future pregnancies as it gives an opportunity for preconception counseling and management prior to the next pregnancy.
When testing for diabetes, it is recommended to repeat testing to confirm unless symptoms are present
It is preferable to repeat the same test for confirmation
The Women’s Preventive Services Initiative (WSPI) recommends the following tests and timeframes
4 weeks to 6 months
OGTT (preferred) | FPG (acceptable) | A1 (consider only when recommended alternatives are not feasible and repeat testing regardless of result)
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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