Centering Pregnancy in Gestational Diabetic

Report
CENTERING PREGNANCY IN GESTATIONAL DIABETIC WOMEN
Presented by Dolores Aguilar, NP-C, CDE, MSN, DNP-C
At the end of the presentation, the participants
will be able to:
 Understand Centering Pregnancy as a model of
group prenatal care.
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Identify leadership characteristics that
contribute to success in leading Centering
Pregnancy groups.
Understand the benefits of Centering group care
to gestational diabetic women in empowering
them to breastfeed their babies and make life
style changes.
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Problem
GDM in Latinas
 Obesity & risk of Type II DM
 Breastfeeding
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Prenatal Care
Routine GDM care
 Group Care
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Project Purpose & Objectives
Project Implementation
(Literature review and
description)
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Evaluation (findings/results)
Limitations and Conclusion
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In the US , over 50 million or 16% of the US
population, are Latinos (US Census, 2011).
Latinas aged 15-44 have the highest birth rates at
9.3% compared to Whites 5.8%, Blacks 6.8%,
Asians 6.8%, and American Indians/Alaskan
Natives 6.2% (Sutton, Hamilton & Mathews,
2011).
US adults (older than 20) 35% are obese, and 17%
are children (CDC, 2011)
50% of Latinas are overweight (BMI 25-30) at
conception (Vahratian, 2009).
© 2008 Santa Clara Valley Health & Hospital System
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Definition:
Hyperglycemia (diabetes) that is
diagnosed in pregnancy (ADA,
2011.)
Stats:
GDM incidence rate in U.S. 7-14%
GDM incidence rate in Latinas 14%
(Ferrara (2007).
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© 2008 Santa Clara Valley Health & Hospital System
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© 2008 Santa Clara Valley Health & Hospital System
Obese women are at 66% risk of
developing diabetes during
pregnancy
Approx. 50% of women with GDM
develop T2DM within 5 years of
GDM diagnosis (Kim, 2002).
Offspring of GDM women are at
increased risk of obesity and
T2DM (Franks, et al., 2010).
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Breastfeeding (BF)
lowers risk of obesity and
T2DM
o Mother
o Offspring
Healthy People 2020
BF Goals
o Initiation rate at birth:
82%
o At 6 months: 61%
o At 12 months: 34%
One of the largest public birthing Center in
California with 4,200 births in 2011.
Maternal Fetal Medicine (MFM):
A multidisciplinary high-risk OB clinic.
Maternal Fetal Medicine (MFM)
Clinic
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A multidisciplinary high-risk
OB clinic.
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Problem with the system: Pregnant women were
using ER as primary care.
Piloted CP to provide comprehensive cultural and
educational care (East coast hosp clinic) .
Population sample (N = 111), LSE, ethnically
diverse, adolescents to 30 years of age.
Group care women were less likely to use ER in
the 3rd trimester (26 % vs. 74%, P 0.001)
Improved teen group attendance 92%,
The women preferred receiving PNC in groups
(96%).
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Care 1:1 on risk
assessment, intervention,
education, & evaluation.
Waiting period to be seen
10-20 minutes.
Each patient is seen for 30
minutes by the nurse
practitioner.
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Women learn skills,
build friendship, and
support.
Empowers women to be
active in their own care.
Learn to be a better
healthcare consumer.
Improves the health of
mother and baby.
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Needing to say things
only once.
Working with
motivated patients.
Finding work fun and
energizing.
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Ickovics, et al., (2007), conducted an RCT study.
N=1047 randomized n=653 in CP and n=394
routine care. Mean age 20 and 80% were African
American women.
CP women had significantly lower odds of
preterm birth( (9.8% vs. 13.8% P.045).
Greater breastfeeding initiation rates (66.5% vs.
54.6% P .001), improved prenatal knowledge,
readiness for labor & delivery, less likely to have
inadequate care (26% vs. 33% P.01) and
improved satisfaction with care when compared
to routine care women.
•Baldwin et al. (2006) Increased
pregnancy knowledge and readiness for
Labor & Delivery.
•Cost-effective : Mooney et al. (2008) if
>120 deliveries a year.
THEORETICAL FRAMEWORK
SOCIAL COGNITIVE THEORY (SCT)
Albert Bandura
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Individuals learn behaviors through social
observation of other individuals, media, social
influences, and learned experiences.
Used to guide practitioners on how to inform,
enable, facilitate, and motivate patients to adopt
healthy habits and behaviors to promote health
and reduce illness (Bandura, 2002).
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Soothing music was
played to provide
privacy during 1:1.
Women were on
average 28 weeks
gestation at
enrollment.
Educational topics are
facilitated and time is
provided for women to
talk and share their
knowledge/experience.
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Interested
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Good listener
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Focused
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Organized but flexible
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Willing to share expertise
PROJECT EVALUATION
Inclusion criteria
Spanish speaking, gestational
diabeticwomen,18-46 years old.
Exclusion criteria
T1DM and T2DM
Recruitment
Via flyers posted in MFM.
By invitation during provider appointments
Data collection
Chart review
Pt interviews
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Breastfeeding initiation at birth and continuation
rates at 1-8 weeks postpartum
Gestational age at 1st prenatal visit
Number of prenatal visits (compliance)
Maternal weight gain
Infant weight at birth
Gestational age of infant at birth
Mode of delivery: vaginal versus C/S
Patient testimonials
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.
One woman shared with the group how she
experienced domestic violence with her exhusband and openly disclosed in detail how the
frequency and severity of abuse made her decide
to leave her abusive relationship.
Coping with violence on a daily basis.
Discussed community resources available to
move on with her life.
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A multiparous participant openly disclosed to the
group that her left nipple was defective (inverted)
that formula was the only option for her.
“I thought I was different, but I learned so much
from the other women and I realized that they
have the same problems and concerns that I do.
They helped me feel better and taught me how to
increase my milk supply and learn different
breastfeeding techniques to be successful in
breastfeeding.”
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A first time mom recognized that newborn safety
was one of the first challenges of parenthood:
“I never had an experience like the educational
guidance in the correct way to strap my baby in
the car seat and I am thankful that the women
were able to share their experience with me and I
feel blessed to have the guidance and support
right when I needed it.”
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Self-selection bias, small sample size, and a
homogeneous group limits the ability to
generalize the information obtained.
In the chart review: Incomplete documentation,
missing data in the medical records, thus limiting
the internal validity of the findings.
Finally, due to the lack of statistical power and
the observational nature of the project and lack
of randomization, results do not indicate a causal
relationship between group model attendance
and maternal and infant outcomes.
Centering
The increase in
breastfeeding rates
demonstrated in this
pilot project supports
the benefits of the
CenteringPregnancy
prenatal care model
for Latina women
with GDM.
Improved Breastfeeding
I
Centering
Participant reports of
knowledge gained
during social
interaction supports
axioms of SCT and
helps explain benefits
of Centering prenatal
care model for Latina
women with GDM.
Participant Satisfaction
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J. Kitzmiller, MD and MFM Staff
M. Nosek, PhD CNM, USF Assistant Professor
(DNP Chair).
J. Lambton, PhD, USF Professor
Centering clients and families
SCVHHS Administration and staff
Sons (Samuel and Michael), family and friends
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American Diabetes Association. Accessed on May 13, 2011, on the Diabetes Care
Web Site at http://care.diabetesjournals.org/content/,30 (Supplement_2): S2512.full.
Bandura, A., Fernandez-Ballesteros, R., Diez-Nicolas, J., Caprara,G., & Barbaranelli,
C. (2002). Determinants and structural relation of personal efficacy to collective
efficacy. International Association for Applied Psychology, 51(1), 107-125.
Centering Healthcare Institute (CHI) accessed on September 28, 2012 from
http://www.centeringhealthcare.org
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Ferrara A. (2007). Increasing prevalence of gestational diabetes mellitus: A public
health perspective. Diabetes Care, 30:S141-45.
Franks, P., Hanson, R., Knowler, W., Sievers, M., Bennett, P., & Looker, H.(2010).
Childhood obesity, other cardiovascular risk factors, and premature death. New
England Journal of Medicine, 362(6), 485-493.
Healthy People 2020: Breastfeeding objectives retrieved on October 1, 2012.
http://www.usbreastfeeding.org/LegislationPolicy/FederalPolicies/ Healthy People
Ickovics, J., Kershaw, T., Westdahl, C., et al. (2007). Group prenatal care and
perinatal outcomes: A randomized controlled trial. Obstetric Gynecology, 110 (2),
330-9.
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Kim C., Newton K., & Knopp, R. (2002). Gestational diabetes and the incidence of type 2
diabetes: A systematic review. Diabetes Care, 25,1822-1868.
Rising, S. (1998). CenteringPregnancy: An interdisciplinary model of empowerment.
Journal of Nursing Midwifery, 43(1), 46-54.
Sutton, P., Hamilton, B., & Mathews, T. (2011). Recent decline in births in the United
States 2007-2009. Centers for Disease Control and Prevention’s National Center for Health
Statistics Division of vital statistics; data brief report No 60. Accessed October 10, 2012
from http://www.cdc.gov/nchs/VitalStats.htm.
U.S. Census. (2011). U.S. Department of Commerce Economics and Statistics
Administration. The Hispanic population: 2010 Census Briefs. Accessed on October 12,
2012 from http://www.census.gov/prod/cen2010/briefs/c2010bc=04.pdf
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Vahratian, A. (2009). Prevalence of overweight and obesity among women of
child bearing age. Journal of Maternal Child Health, 13(2), 268-273.

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