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 why screening all women for GDM rather than only those with risk factors is appropriate
2. Assess a patient for risk factors for gestational diabetes that should prompt and early screening in pregnancy
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
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.
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 2020, 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.
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.
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.
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Professional organizations agree that all pregnant women should be screening for Gestational Diabetes Mellitus (GDM). While there are varying approaches, ACOG and a consensus panel convened by the NIH have endorsed the following ‘2 step’ approach to screening for GDM:
STEP 1: All women should be screened for GDM between 24 and 28 weeks gestation with a 50g oral glucose solution followed by a 1 hour venous glucose measurement. Healthcare providers have the option of using the following values:
Patient is overweight with BMI of 25 (23 in Asian Americans) and one of the following:
If a patient with risk factors is tested earlier and is screen negative, the patient should still be screened again between 24-28 weeks using the 50g oral glucose load.
STEP 2: If screen positive following STEP 1, a diagnostic test, the 100g 3 hour oral glucose tolerance test (OGTT), is recommended. A diagnosis is made if at least two values are exceeded using one of two methods:
Note: In new ACOG guidelines, due to increased complications with even a single elevated abnormal value, 1 abnormal value may be used to diagnose GDM.
National Diabetes Data Group
Carpenter and Coustan
Note: The ADA has removed the National Diabetes Data Group from its guidelines and recognizes ‘2 step’ Carpenter and Coustan approach or ‘1 step’ approach (see Related ObG Topics below) to both be valid for GDM diagnosis
GDM is a common complication of pregnancy, possibly affecting 9.2% of all pregnancies (CDC 2010) and appears to be increasing. Aside from well known complications associated with birth trauma and increased risk of operative delivery and preeclampsia, there may be long term complications including increased risk of obesity and diabetes later in life, although maternal obesity and excessive weight gain may be independent risk factors for macrosomia and childhood obesity. Treatment for GDM does appear to improve outcomes. Screening all women is necessary as traditional risk factors may only detect 50% of GDM.
Diagnosis code: Gestational diabetes mellitus in pregnancy
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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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