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Managing gestational diabetes mellitus: Audit data of outcomes for women and neonates

02 December 2018

Service Audit

02 December 2018

Volume 26 · Issue 12

ISSN (print): 0969-4900

ISSN (online): 2052-4307

Abstract

Background

Literature on the management of gestational diabetes mellitus (GDM) and other pre-existing diabetic conditions in pregnancy suggest treatments that may ameliorate outcomes for both mother and neonates.

Aims

To examine the effects of GDM on outcomes for mothers and neonates and the effects of maternal age, body mass index and gestational age at birth with or without induction of labour for women with GDM.

Methods

Audit data of outcomes for GDM groups were analysed against outcomes for the general population of women giving birth in this unit. Descriptive statistics organised the data and inferential statistics determined the significant differences between frequencies.

Findings

Most of the results were predictive when comparing women with and without GDM for mode of birth and outcomes for mothers and neonates. This included significant differences for hospital birth, induction of labour and caesarean section.

Conclusion

Good glycaemic control and healthy lifestyle measures are advised to minimise development of obesity in women with GDM and diverse outcomes for both mothers and neonates.

Gestational diabetes mellitus (GDM) is defined as glucose intolerance, increased insulin resistance and usually occurring in the second trimester of pregnancy (HAPO Study Cooperative Research Group, 2008; McCance, 2011). The condition is associated with increased risks and poorer outcomes of pregnancy for both mother and neonate, which are attributed to the increased prevalence of obesity, insulin resistance and hypertension in childbearing women. The condition affects 3-5% of all pregnancies in the Caucasian population (Grabowska et al, 2017). According to Hedderson et al (2012), increased risk of GDM varies with body mass index (BMI) thresholds, and by racial/ethnic groups in Asian and south-east Asian women, who may need preventative strategies in addition to weight management interventions.

Any woman diagnosed with GDM can expect to be monitored more frequently, which may lead to interventions in pregnancy and labour. In addition, the mother's diabetes may lead to over-exposure to the hyperglycaemic conditions in utero and the health of the fetus being compromised. After birth, the neonate may display clinical complications of hypoglycaemia, hyperbilirubinaemia, polycythaemia and respiratory distress syndrome, among others (National Institute for Health and Care Excellence (NICE), 2015).

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Gestational diabetes mellitus

Induction of labour

Obesity

Glycaemic control

Midwife's role

Audit