Abstract

Purpose/Background: Gestational diabetes mellitus (GDM) affects approximately 240,000 pregnancies annually and is associated with maternal adverse events (hypertension, preeclampsia, polyhydramnios, preterm delivery) and neonatal complications (macrosomia, shoulder dystocia, and increased morbidity). Timely diagnosis and treatment improves outcomes. Traditionally, women without known diabetes have been screened at 24-28 weeks using a two-step procedure: a one-hour glucose challenge test and, if abnormal, followed by a fasting three-hour glucose tolerance test (GTT) on another day. Current literature and the American Diabetes Association support a one-step approach in which women are screened with a one-time fasting two-hour GTT. At our women's center, we observed delays in diagnosis and treatment using the two-step approach with women taking an average of 15 days to complete step two.

Summary: PICO Question: In low-income pregnant women receiving care at a hospital-based outpatient women's center, what is the effect on time to diagnosis and treatment of a one-step approach compared with the two-step procedure in diagnosing GDM?

Methodology: We piloted a one-step GDM screening approach (n=100 women) and assessed baseline two-step procedure information (n=319 charts).

Results (One-step vs. Two-step): GDM diagnosis: 10:100 patients (10%) vs. 17:319 patients (5%). Mean time from abnormal screen to treatment: 10 days vs. 29 days. Mean gestational age at treatment: 29 weeks vs. 31 weeks.

Outcomes: With the one-step approach, GDM is diagnosed on the same day, more frequently, and treatment is on average 19 days earlier than with the two-step approach.

Implications for Women's Health: Results of this project support using the one-step approach for prompt GDM diagnosis and treatment in this population.

Author Details

Catherine Cornish, MS, RN, WHNP-BC

Sigma Membership

Non-member

Type

Presentation

Format Type

Text-based Document

Study Design/Type

N/A

Research Approach

N/A

Keywords:

Gestational Diabetes, One-Step, Screening

Conference Name

19th Annual NPWH Premier Women's Healthcare Conference

Conference Year

2016

Conference Location

New Orleans, Louisiana, USA

Conference Host

Nurse Practitioners in Women's Health

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Abstract Review Only: Reviewed by Event Host

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Proxy-submission

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