Author

Sally Hersh

Date

August 2013

Document Type

Portfolio

Degree Name

Ph.D.

Institution

Oregon Health & Science University

Abstract

Maternity care providers are witnessing an increase in the number of obese pregnant women and the associated rise in the prevalence of gestational diabetes mellitus (GDM) (Marshall, 2012). Almost two-thirds of women in the United States are overweight or obese (Flegal, Carroll, Ogden, & Curtin, 2010). Data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) revealed an age-related prevalence rate of obesity among adult women of 35.5%, noting a range of 33% for non-Hispanic white women to 49.6% for non-Hispanic black women (Flegal, et al., 2010). Obese women, who are known to enter pregnancy with increased insulin resistance, have a two to three times increased odds ratio of developing GDM (Gibson et al., 2012). Maternal obesity and GDM are independently associated with adverse outcomes for mother and baby (Catalano et al., 2012). Pregnant, obese women have an increased risk of preeclampsia, abnormal fetal growth, stillbirth, and cesarean birth (N. E. Marshall, Guild, Cheng, Caughey, & Halloran, 2012). Offspring born to women with GDM have higher birth weights. In addition, children of women with fasting and daily hyperglycemia are at risk for becoming overweight during adolescence (Tzanetakou, Mikhailidis, & Perrea, 2011). Gabbe et al. (2012) urge maternity care providers to assume a substantial role in assisting women to improve their families’ health during and after the birth of their babies. With the Oregon Health & Science University (OHSU) Department of Obstetrics and Gynecology’s July 1, 2012 adoption of an international consensus panel’s (IADPSG Consensus Panel, 2010) GDM screening criteria, it is expected that the number of OHSU patients diagnosed NURSE-MIDWIFERY IMPLEMENTATION OF NEW IADPSG GDM SCREENING CRITERIA with gestational diabetes will rise (ADA, 2012b). There is interest in designing care and research to support the recommendations for diet and exercise that form the foundation of diabetes care. However, clinicians and researchers perceive barriers in their ability to capture data and assess the impact of the change in GDM screening criteria on the OHSU pregnant population. The purpose of this project is to describe the implementation of the IADPSG GDM screening criteria in the OHSU system and select obstetrical outcomes of pregnant women diagnosed with gestational diabetes by the IADPSG criteria while enrolled for nurse-midwifery care at OHSU between June 1, 2012 and February 28, 2013.

Identifier

doi:10.6083/M46M34VW

School

School of Nursing

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