Development and Evaluation of Protocol for Early Screening For Diabetes in Pregnancy: A Quality Improvement Initiative

Abstract

Diabetes Mellitus is a dangerous condition known to cause adverse effects to both mother and fetus. Rates of diabetes are increasing worldwide. Research indicates that undiagnosed pre-existing, or overt, diabetes may increase poor outcomes in pregnancy; therefore, new recommendations from healthcare organizations endorse first-trimester screening for undiagnosed pre-existing diabetes in at-risk patients. Diabetes screening during pregnancy has long-been studied, and universal screening for gestational diabetes between 24 and 28 weeks gestation is endorsed by all major healthcare organizations. However, until recently, little research explored pre-existing diabetes and related effects on pregnancy. In 2018, the American College of Obstetricians and Gynecologists released new recommendations regarding screening at-risk patients in the first trimester of pregnancy. However, many providers have not yet begun to implement this testing. This project chronicles the development and evaluation of a protocol designed to identify and screen at-risk patients in the High-Risk Obstetrics clinic in an academic medical center located in a Midwestern city. After a review of the current literature, an evidence-based protocol for screening for overt diabetes in early pregnancy was developed. An inter-professional expert panel evaluated the protocol using the REDCap system, and the results were analyzed using qualitative and quantitative methods. Upon review and analysis, much of the evaluation results were positive, but some areas for improvement were clear. Evaluation was broken down by theme, to identify patterns in results. This information was then employed in developing a second, and final, draft of the Protocol. The response of a multi-professional provider review team supports adoption of this protocol; therefore, after making recommended alterations in format and content, this protocol will be considered for introduction in the High-Risk Obstetrics Clinic detailed in this document. Indicated follow-up study should include determining the early diagnosis rates of diabetes in pregnancy, as well as a cost analysis of the available methods of testing in early pregnancy. Keywords: diabetes, prenatal care, screening, protocol, diabetes in pregnancy, overt diabetes