EIP PORTFOLIO

PRESENTATION
GDM SCREENING
Stephanie Preston, student midwife
Assess
◦ A client presents to your office at 26 weeks gestation. A discussion is

had with the client about the importance of screening for gestational

diabetes mellitus and their individual risk factors. The client determines

that they would like to undergo screening but aren’t sure which

method they would like to use. They have some concerns about

ingesting the standard 50 mg glucose drink since they don’t consume

a lot of sugar on a daily basis.

Ask
◦ P: This would pertain to all pregnant clients between
24-28 weeks gestation. Screening for gestational
diabetes is recommended for all pregnant people
during this time frame so a choice of screening
method or to decline entirely is a decision to be ◦ What are the options
made by all pregnant people who have sought care.
screening for gestational
◦ I/E: The main intervention we are considering is a
50mg 1 hour glucose tolerance test. We would like to diabetes mellitus, which is
screen for gestational diabetes using this or another
screening option. most effective and what is
◦ C: The comparison is comparing various screening the difference in efficacy
methods such as postprandial blood glucose, and 1
and 2 step glucose tolerance tests or various other between the most effective
alternatives. and the alternatives?
◦ O: Outcome is determining the most effective
method for screening for gestational diabetes and
the difference between the most effective method
and the alternatives.
Acquire
◦ Keywords used ◦ The search strategy I used was to use
◦ Gestational diabetes mellitus screening the keywords above and the
◦ Postprandial GDM screening restricted year range to search for
◦ Alternative GMD screening studies. I reviewed the abstract and
title of the studies for key words that
◦ Search was limited to the last 5 years
talked about comparing different
◦ Databases used were styles of screening and their efficacy
◦ PubMed full search as well as the type of study that it was,
◦ Google scholar looking for systematic reviews,
◦ OVID randomized control trials, and meta-
analysis. All of the studies I chose were
easily found in the first few search
results.
Appraise – Article #1
Farrar, D., Duley, L., Dowswell, T., Lawlor, DA. (2017) Different strategies for diagnosing gestational diabetes to improve maternal and
infant health. Chochrane Database of Systematic Reviews 2017, 8(CD007122) DOI: 10.1002/14651858.CD007122.pub4

◦ This article is relevant because firstly it
looked at several main comparisons of
different methods of screenings which is
the main thing I am looking at to
determine if one method of screening is
superior to another and if alternatives
are accurate for screening. The second
reason this article is relevant is because it
also highlights what research is missing
and still needs to be done to make a
solid evidence based recommendation.
◦ This study is a high-quality and valid
study. This systematic review only
selected randomized studies, they were
selective on which studies met their
criteria, they had authors independently
review the studies and then discuss their
findings, and they looked into both long
and short term outcomes as well as the
health of both the birthing person and
the fetus.
Appraise – Article #2
Donovan, L., Hartling, L., Mulse, M., Guthrie, A., Vandermeer, B., & Dryden, D. (May 2013) Screening tests for gestational diabetes: a systematic review for the
U.S. preventive services task force. Annals of Internal Medicine 2013 (159,2) 115-122.

◦ This study is relevant because firstly is This study is high quality and valid. This
reviews screening test options for study also used authors working
gestational diabetes and their test independently to review the studies and
characteristics and secondly because then come together to compare
it reviews and compares to the 50mg findings, they search for studies in a
glucose challenge test which is the wide variety of databases to find as
current standard in North America. many as possible, they extracted data
themselves to compare the outcomes,
and they only used prospective studies
so the testing could be more
standardized.
Appraise – Article #3
Balaji Bhavadharini, B., Mahalakshmi, M., Maheswari, K., Kalaiyarasi, G., Anjana, R., Deepa, M., … , Mohan, V. (2015). Use of capillary
blood glucose for screening for gestational diabetes mellitus in resource-constrained settings. Acta Dibetologica (53) 91-
97. doi: 10.1007/s00592-015-0761-9

◦ This study is relevant because it
compares one method that the other
studies did not compare which is to use
a capillary blood glucose measurement
in comparison to a venous blood
glucose screen to determine if it is as
accurate. A second reason this test is
relevant is because it speaks to areas of
low resource which often clients seeking
our care want to choose the cheapest
option possible to avoid further lab
expenses.
◦ This study has a sufficient sample size to
detect differences, their methods were
precise in ensuring that small details
were matching and done the same way
for each client, they gave detailed
information on cut off values and
different methods used to give more
detailed information, and it was done as
her perspective study so that all methods
could be standardized. Each client did
both methods of screening to
accurately compare which test
Apply and Assess
◦ I will recommend screening to my clients. Based on the information in these studies I would not feel
confident recommending some alternative methods such as the capillary blood glucose screening
unless they insisted on not receiving the drink. I also feel like there has to be more research out there
somewhere on postprandial at home glucose monitoring and in theory that is the method I like the most.
It doesn’t force my clients to ingest a large amount to sugar especially if they aren’t eating that much on
a regular basis to begin with and it is less invasive for the client, but the research that I found for this
portfolio did not support using that method unless just strictly used to weed out low risk and then take
others for further screening. Based on the research found the 2 step method that is currently standard in
north America is the method I would recommend due to its cost effectiveness and ease of availability.
◦ The tool I will use is to monitor the incidence of GDM in my practice and the method of screening that
was used as well as the treatment offered if it is diagnosed. I will also periodically review studies and new
research for better and more effective screening methods