Columbus County Health Department Policy and Procedure
Diabetic Screening for Maternity Patients
Policy Title:
Diabetic Screening For Maternity Patients
Program Area:
Maternal Health
Policy Identifier:
(optional)
Effective Date:
Approval Date:
Revision
Date(s):
2/25/2005
3/16/2005, 5/4/2010, 01/13/2015
Approved by:
Kim Smith RB, BSN, MSHCA, Health Director
Approved by:
Hilda Memory RN, BS, MSHA, Director of Nursing
Lisa Stevens- Nurse Midwife, Laura Schultz- Nurse Midwife
Purpose:
Identify patients who develop diabetes during pregnancy and provide information,
monitoring, referral and follow-up to promote optimum health of mother and baby.
Definitions:
To promote and maintain a healthy pregnancy through early detection and continuous
care of prenatal patients with diabetes.
Responsibilities:
Nurse Practitioner, Nurse Midwife, Public Health Nurse, Support Staff
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Columbus County Health Department Policy and Procedure
Diabetic Screening for Maternity Patients
Procedures:
A. Blood sugar screening
1.
2.
3.
Glucose tolerance screening (GTS) — 50 gm oral glucose given without
regards to time of last meal or time of day. Venous blood tested after one (1)
hour — normal if below 130 mg/dl.
If GTS is elevated ( > 130 mg/dl), return to clinic fasting (no food after
midnight on the night before the test. Nurse to schedule in the lab,
document appointment in chart and inform patient.
Interpretation of results via Carpenter/Coustan conversion
Status
Plasma or Serum Glucose Level
(Below) mg/dl
Fasting
<95
One Hour
<180
Two Hours <155
Three Hours <149
4.
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If two or more tests are elevated, diagnosis — Gestational Diabetes Mellitus
(GDM)
a.
Put in High Risk Clinic
b.
Order Hemoglobin A1c
c.
Refer to Nutritionist for ADA Diet (2200 cal.)
d.
All pregnant patients with elevated blood sugars will receive:
 dietary education and counseling
 Home glucose self monitoring education/counseling
 Self home glucose monitoring qid (fasting and 3 pp glucose
checks as is standard of care.)
e. GDM patients will be referred to our in-house Registered
Dietician for education and counseling. However, if the dietician
schedule is book up the patient will be referred to Columbus
Regional Healthcare Systems diabetic education classes. The
staff will attempt to provide counseling for all Hispanic patient’s
here at CCHD due to the availability of interpreters.
f. The maternity clinic nurse (RN) will teach the patients
regarding the use of the glucose monitor, maintenance, and
documentation of results.
g. If patients are non complaint with their home glucose
monitoring the practitioner will order weekly fasting and 2 hr
pp at CCHD.
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Columbus County Health Department Policy and Procedure
Diabetic Screening for Maternity Patients
Interpretation of Results: Normal if
Fasting.......Below 100 mg/d1
2 hours pp...<120 mg/dl
Use resources above for consultation and referral as needed.
e.
5.
Consult Physician back for monitoring plan or refer to
Physician Care. Resources: Coastal OB/GYN Wilmington
910-343-7001, Fax 910-343-2109 or Baldwin Woods
OBGYN, Whiteville @ 910-642-3294, Fax 910-640-1110.
Patients with history of diabetes, symptomatic or present with
multiple risk factors should receive a fasting blood sugar or GTS before 24
weeks (16 — 20 weeks). Refer to Nurse Practitioner or M.D. if elevated
above 140 mg/dl; otherwise follow monitoring plan indicated above.
B. Patient preparation for 3 hour GTT (copy for patient handout):
Eat liberally, may have an "unrestricted diet" (>150 gm of carbohydrates)
for 3 days prior to the test. Fast overnight or at least 8 hours before the test.
No food, chewing gum or drinks! No smoking!
Note: May only have a little water while brushing teeth. Report to
clinic at 8:30 a.m.!
Then, just relax!!! Remain seated during the test, enjoy your
favorite book. The testing process will take about 3 ½ hours.
(See 3 Hour GTT Standing Order)
C. Pretest Prep for Diabetes Screening:
If patient experiences nausea and vomiting with the Cola drink,
Refer to the Nurse Practitioner, Nurse Midwife, or M.D. for prescription.
a. Prescribe: Zofran 4-8mg po in the morning prior to the
appointment.
b. Patient to report back to Health Department as scheduled
D. Follow Up of GDM after delivery:
Recommended all GDM have postpartum gestational Diabetes Mellitus follow up testing, for
which this purpose is defined by ACOG as:

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6-12 week postpartum fasting plasma glucose or 75 gm 2 hr oral glucose tolerance test.
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Columbus County Health Department Policy and Procedure
Diabetic Screening for Maternity Patients

Appropriate longer term sequel counseling should be performed (ACOG/Guidelines for
Maternal care).

Recommend further follow up with adult health primary care clinic or primary care physician
of choice,

Re-enforce with patient the importance of monitoring and follow up with blood sugar levels.
Laws and Rules:
Reference(s):
ACOG, Guide to Perinatal Care.
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