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Special Edition: Title V Technical Assistance MeetingExpand Special Edition: Title V Technical Assistance Meeting
Title V Technical Assistance Meeting

 Gestational Diabetes: Consequences and Solutions

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By Cynthia S. Shellhaas, MD, MPH

Gestational Diabetes (GDM) may impact as many as 9.2 percent of pregnant women, according to a 2014 report from the Centers for Disease Control and Prevention (CDC). Because GDM is most commonly associated with immediate complications, the emphasis is often on managing the disease during pregnancy, but up to 70 percent of women with gestational diabetes will develop Type 2 diabetes mellitus (T2DM) in their lifetime. Both the ADA and ACOG recommend that women previously diagnosed with GDM are screened for pre-diabetes and diabetes at six to 12 weeks postpartum and regularly throughout their lives. Only half of women even undergo postpartum screening.  

The Ohio Gestational Diabetes Postpartum Care Learning Collaborative was formed in January 2014 as a quality-improvement initiative and is sponsored by the Ohio Department of Health (ODH) and administered by the Ohio Colleges of Medicine Government Resource Center. Its primary objectives are to increase postpartum visit rates and postpartum T2DM screening rates in women with a history of GDM. Secondary objectives are to educate women on T2DM risk and risk-reduction methods. To achieve these goals, the project engages national experts and clinical practice sites throughout Ohio to participate in a QI initiative utilizing a modified version of the Institute for Healthcare Improvement (IHI) Model for Improvement.

Practice sites – which consist of teams of OB/GYNs, nurse practitioners, midwives, and diabetes educators – participate in monthly learning sessions to share best practices, complete PDSA (plan-do-study-act) cycles, collect data and receive rapid cycle feedback. Clinical sites participating in the collaborationve are located in both rural and urban areas across Ohio and serve populations in which where over half of the people are covered by Medicaid. Many of these clinical sites are from one of the nine communities that comprise the Ohio Equity Institute (OEI) – a partnership between the Ohio Department of Health and the CityMatCH project – which focus on improving birth outcomes and reducing racial disparities in infant deaths. In addition, populations at high risk for diabetes (such as African-American, Hispanic and Appalachian) are a priority.

The first six months of the project were spent developing toolkits for providers and patients. Practice sites were trained on how to implement project resources, including provider and consumer toolkits. The consumer toolkit, which was created in English and Spanish and written at a fourth- to fifth-grade reading level, provides women with information on their GDM diagnosis, recommended nutrition, breastfeeding and the risk of T2DM. The provider toolkit includes information for educating patients on how to manage GDM as well as algorithms for screening and diagnosing GDM, and tools to improve care coordination between providers and office work flow.

To learn more about our project and gain access to the provider and consumer toolkits, visit our website, ohiogdm.com, which is scheduled to launch June 20.

 

DeSisto CL, Kim SY, Sharma AJ. Prevalence Estimates of Gestational Diabetes Mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007–2010. Preventing Chronic Disease 2014;11:130415.

Tovar A, Chasan-Taber L, Eggleston E, Oken E. Postpartum screening for diabetes among women with a history of gestational diabetes mellitus. Preventing Chronic Disease 2011; 8: A124.