CMECNE

What Is The ‘One-Step’ GDM Screening Approach?

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. Recall the correct amount of glucose that is administered in the one step GDM screen
2. List the fasting, one hour and 2 hour plasma glucose values necessary to diagnose gdm in the one step gdm screen

Estimated time to complete activity: 0.25 hours

Faculty:

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 Genoox, Inc., 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 2019, 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.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

There is no debate that all pregnant women should be screened for Gestational Diabetes Mellitus (GDM) between 24 and 28 weeks. However, there are two different approaches to screening for GDM. ACOG currently prefers the traditional ‘two-step’ approach, using an initial screen that, if positive, requires an additional confirmatory test. Alternatively, there is the option of the International Association of Diabetes and Pregnancy Study Groups that recommend a ‘one-step’ approach as follows

Perform a 75 g oral glucose tolerance test on all women, after an overnight fast, not previously found to have overt diabetes or GMD earlier in pregnancy
Diagnose GDM when one or more of the following plasma glucose values are exceeded
- Fasting ≥ 92 mg/dL (5.1 mmol/l)
- 1-hour ≥ 180 mg/dL (10.0 mmol/l)
- 2-hour ≥ 153 mg/dL (8.5 mmol/l)
Early screening for overt diabetes in women at high risk for type 2 diabetes is recommended by this professional group at the first prenatal visit to allow for early detection and management for complications such as fetal anomalies and potential microvascular disease in the mother
- If fasting plasma glucose is ≥92 mg/dL (≥5.1 mmol/l) but < 126 mg/dL (7.0 mmol/l) diagnose GDM
- Overt diabetes as per standard cut-offs

SYNOPSIS:

Unfortunately, with the obesity epidemic and more sedentary lifestyles, GDM is increasing as well, and being observed in younger age groups. Complications are significant, including birth trauma to both mother and child. Treatment including diet, increased exercise and if necessary medications can be effective, if GDM is identified in time to implement these changes to achieve best results.

KEY POINTS:

ACOG and consensus panel convened by the NIH do not recommend the ‘one-step’ approach, but rather the ‘two-step’ approach
- Centers can adopt ‘one-step approach’ if more clinically applicable for a particular population
The ‘one-step’ screening approach will result in increased diagnosis of GDM
The controversy relates to whether with the increased costs and resources necessitated by the ‘one-step’ approach will result in improved outcomes
Targeting obesity and improved nutrition can also address macrosomia risks
The ADA recognizes ‘2 step’ Carpenter and Coustan approach or ‘1 step’ approach (see Related ObG Topics below) to both be valid for GDM diagnosis