National Nurse Practitioner Week: Shedding Light on the Important Role of Women’s Health Nurse Practitioners

The following was written by Shawana Moore, DNP, MSN, CRNP, WHNP-BC. Dr. Moore is an Assistant Professor and Women’s Health-Gender Related Nurse Practitioner Program Director at Jefferson University, as well as an NPWH Board Member. 

November 10th-16th, 2019, we celebrate nurse practitioners (NPs) throughout our nation for their extraordinary contribution to society. NPs care for individuals throughout the lifespan, lead healthcare systems, advocate for health policies, educate communities, and transform the way healthcare is delivered.

Statistics on Nurse Practitioners

  • 270,000 practice in the United States1
  • 1% have graduate degrees2
  • Hold prescriptive privileges, including controlled substances, in all 50 states and the District of Columbia3

Specialty Areas Available for Nurse Practitioners

There are multiple speciality areas in which nurse practitioners can obtain their primary certification. These include:

  • Women’s Health Nurse Practitioner
  • Neonatal Nurse Practitioner
  • Primary Care Pediatric Nurse Practitioner
  • Acute Care Pediatric Nurse Practitioner
  • Adult-Gerontology Nurse Practitioner
  • Adult-Gerontology Acute Care Nurse Practitioner
  • Family Nurse Practitioner
  • Psychiatric Mental Health Nurse Practitioner

Women’s Health Nurse Practitioners

Women’s health nurse practitioners (WHNPs) specialize in the care of women and make up 2.7% of NPs.3 According to a survey completed by the American Association of Nurse Practitioners in 2018, most WHNPs work as part of a private practice obstetrics and gynecology group.3 WHNPs practice in inpatient and outpatient settings, treating individuals throughout their lifespan and caring for their sexual and reproductive health care needs with a comprehensive and holistic approach.

Practice Settings Include:

  • Urogynecology Clinics
  • Gynecology-Oncology Clinics
  • Primary Care Clinics
  • Obstetric Triage Units
  • Breast Health Centers
  • Obstetric and Gynecology Outpatient Clinics
  • Postpartum Units
  • Reproductive Endocrinology & Infertility Offices
  • Maternal-Fetal Medicine Clinics
  • Sexual Health Practices
  • Women’s Correctional Facilities
  • Family Planning Clinics or Health Centers

Areas of Care Include:

  • Well-women care
  • Adolescent health
  • Contraceptive counseling
  • Transgender health
  • Pregnancy testing
  • Infertility treatment
  • Sexual Health
  • Male reproductive and sexual health
  • Menopausal health
  • Sexually transmitted infection treatment
  • Screening for general health problems
  • Breast health
  • Gynecological cancers

Resources

Facts about the women’s health nurse practitioner can be found on Nurse Practitioner & Women’s Health Nurse Practitioner Practice Facts website provided by the National Association of Nurse Practitioners in Women’s Health. Additionally, WHNP Guidelines for Practice and Education – 7th Edition, provides information on the role of women’s health nurse practitioners, practice guidelines and competencies of practices.

During this special week, let us take time to recognize the significance of nurse practitioners and the role of women’s health nurse practitioners in improving the lives of women everywhere.

 

References

  1. AANP National Nurse Practitioner Database, 2019.
  2. American Association of Colleges of Nursing (AACN). (2019). 2018-2019 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Washington DC: AACN.
  3. 2018 AANP National Nurse Practitioner Sample Survey.

Preconception Care for Women Living with Diabetes

Brandee Newsom, APRN, BC-ADM, CDE, works in Perinatal Diabetes Management at the High Risk Pregnancy Center in Las Vegas, NV. She recently presented on gestational diabetes at our 2019 Annual Conference. She shares the below for World Diabetes Day.

Today is World Diabetes Day, and as practitioners who care for women, it’s critical that we understand how this condition impacts our patients -especially when it comes to pregnancy. Diabetes can be managed before and during pregnancy to mitigate the risks to our pregnant patients and improve their long-term health. I offer this overview of screening and diagnosis, risk reduction, and the latest developments so we can provide quality care to our patients with diabetes and those at risk for diabetes.

By the Numbers

People living with diabetes are 2-4 times more likely to develop and die from heart disease or stroke. These risks are greater in women than men. Women with diabetes who become pregnant have a 10-20% chance of developing preeclampsia in addition to other adverse outcomes.

Screening and Diagnosis

If a woman is at risk for diabetes, she should be screened and counseled regarding risks. This includes women with the following risk factors:

  • Overweight/obese
  • Family history of diabetes
  • High blood pressure
  • High cholesterol
  • PCOS
  • Ethnicities including Native American, Asian, African American, Hispanic, or Pacific Islander
  • History of gestational diabetes or macrosomic fetus
  • History of cardiovascular disease

Criteria for the diagnosis of diabetes:

  • Fasting plasma glucose ≥126 mg/dL (fasting is defined as no caloric intake for at least 8 hours)*
  • 2-h PG ≥200 mg/dL during 75-gram glucose tolerance test*
  • A1C ≥ 6.5%*
  • Random plasma glucose ≥200 mg/dL, with classic symptoms of hyperglycemia or hyperglycemic crisis

(* In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal test results from the same sample or in two separate test samples.)

Any woman with diabetes should be counseled if they are planning a pregnancy within the year. Referring to an MFM specialist for a prepregnancy consultation can be helpful in this regard especially if the patient has additional risk factors.

Reducing Risk for Mother and Baby

In optimizing the health of the mom, fetus and neonate, the two key modifiable risk factors are BMI and blood sugar levels. In this regard:

  • Prior to pregnancy their A1C should be less than 6.0%, their fasting blood sugar should be <95 and 2 hours after meals should be < 120.
  • For optimal risk reduction, they should try and achieve a normal BMI prior to conception.
  • Excellent nutrition and a moderate amount of exercise are imperative for improving health, especially for women with diabetes planning a pregnancy. Referrals to a certified diabetes educator (CDE), a Registered Dietitian (RD/RDN), or a Diabetes Program that is recognized by the ADA/AADE can help.
  • They should have screening for any diabetes related complications such as heart disease, hypertension, or thyroid disease.
  • They should be up to date on their eye and dental exams as well as their vaccinations.
  • Since these patients have an increased risk of neural tube defects, they should be taking folic acid at least 3 months prior to conception and through the first trimester.

New Developments

The link between diabetes and cardiovascular disease has been well established. Even gestational diabetes and future risk of cardiovascular disease has been well studied. Interestingly, a retrospective study published in the Lancet in March 2019 shows that the risk of cardiovascular disease extends into the non-diagnostic range for glucola results. It showed that for each 1 mmol/L increment in the glucose challenge test result was associated with a 13% higher risk of cardiovascular disease after adjustment for age, ethnicity, income, and rurality. This relationship persisted after excluding women with gestational diabetes.

Helpful Resources

ACOG committee opinion on Prepregnancy Counseling

ACOG FAQ handout for patients Healthy Pregnancy for Women with Diabetes