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OB
CMECNE

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

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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 faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

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 Jan 25 2023, 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

Learn More – Primary Sources:

International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy

NIDDK– Test Criteria for Prediabetes, Diabetes, and Gestational Diabetes

ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus

ADA Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2020

Take a post-test and get CME credits

TAKE THE POST TEST

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Related ObG Topics:

Updated ACOG Guidance on Gestational Diabetes
Practical obstetrics info for your women's healthcare practice
Screening for Gestational Diabetes: The ‘2 Step’ Approach
Practical obstetrics info for your women's healthcare practice
GDM and Postpartum Followup – The ‘When and How’ of Screening
Practical info on evidence based medicine for your women's healthcare practice
Addition of glyburide in mild GDM-is there benefit?
Practical obstetrics info for your women's healthcare practice
Gestational Diabetes Mellitus – Definitions, Risk Factors and Complications
Practical obstetrics info for your women's healthcare practice

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Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

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.

Disclaimer

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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