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Choice of planned place of birth for women with diet-controlled gestational diabetes mellitus

02 October 2016

Service Audit

02 October 2016

Volume 24 · Issue 10

ISSN (print): 0969-4900

ISSN (online): 2052-4307

Abstract

Background:

Women with diet-controlled gestational diabetes have been excluded from birthing in one midwife-led birth centre due to an assumed risk of complications.

Aims:

This study aimed to examine the rates of adverse outcomes for women diagnosed with gestational diabetes who have controlled their hypoglycaemia through dietary change, but who may be excluded from birthing in a midwife-led centre owing to risk of complications, to identify whether outcomes are the same for these women as for other low-risk women giving birth in one local maternity unit.

Methods:

Retrospective analysis was conducted of data on low-risk women giving birth at a maternity unit in the South East of England to compare the birth outcomes of women with or without gestational diabetes. Data were analysed in Microsoft Excel and presented as descriptive statistics.

Findings:

In 2014, a total of 164 out of 4032 women who gave birth at the maternity unit had gestational diabetes. Among these, 89 were controlled through diet alone. Data for 4 months in 2015 were also examined for 57 women with gestational diabetes.

Conclusions:

The mode of delivery and outcomes for the women in this cohort who remained normoglycaemic have been found to be in line with the general outcomes for all women at this hospital during the study period. The women diagnosed with gestational diabetes but well controlled on diet had similar outcomes to low-risk women giving birth at the maternity unit. The small sample size means further work is needed to confirm the findings, but indicates that the option of using the birth centre may be considered a reasonable alternative for these women.

Gestational diabetes mellitus (GDM) is an asymptomatic pregnancy-related condition normally identified by initial screening followed by diagnostic testing (Carr, 2001). The condition is a risk factor for the woman and fetus where there is an association between increasing glucose and adverse outcomes (HAPO Study Cooperative Research Group, 2008). In addition, GDM is a risk factor for maternal type 2 diabetes, offspring obesity and cardio-metabolic ill health (Seabra et al, 2015). The evidence to date remains unclear as to the diagnostic procedure of GDM (Farrar et al, 2011) and the impact of hyperglycaemia on adverse pregnancy outcomes (Yogev et al, 2009; Tieu et al, 2010). However, Farrar et al (2015: 795) suggest that ‘diagnostic criteria for gestational diabetes recommended by UK NICE [National Institute for Health and Care Excellence] (2008) might underestimate the prevalence of gestational diabetes' compared with their criteria, or recommendations made by the International Association of Diabetes and Pregnancy Study Group Consensus Panel (2010) for thresholds based on the Hyperglycemia and Adverse Pregnancy Outcomes study (HAPO Study Cooperative Research Group, 2008), which are also recommended by the World Health Organization (WHO, 2013).

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Gestational diabetes

Diet

Planned place of birth

Midwife-led unit

Birth centre