ABSTRACT: Few studies have evaluated the effectiveness of nurse-based management programs in women with gestational diabetes mellitus (GDM) to improve perinatal outcomes and increase the frequency of postpartum glucose screenings. Telephone counseling has been shown to be highly effective in supporting self-care for a variety of populations with diabetes and other diseases but has not been used for nurse management programs in women with GDM.
The aim of this study was to determine whether referral to a telephonic nurse management program was associated with improved perinatal outcomes (lower risk of macrosomia and low-birth-weight infants) and a higher frequency of postpartum glucose testing among a population of women with GDM. There is a variation in the percentage of patients referred to a telephonic nurse management program at 12 Kaiser Permanente medical centers. This allowed the use of a quasi-experimental design through stratification of telephone referrals by center to investigate the association between referral to the program and a lower risk of macrosomia and low birth weight and also the increased use of postpartum glucose testing. Of 11,435 women with GDM identified between 1997 and 2007 at the 12 medical centers, 44.5% were referred to the perinatal service center.
Compared with patients from medical centers where the annual proportion of referrals to telephonic nurse management was less than 30%, patients from medical centers with an annual referral proportion greater than 70% at the time of delivery were less likely to have a macrosomic infant (multiple-adjusted odds ratio, 0.75; 95% confidence interval, 0.57–0.98) and were more likely to have postpartum glucose testing (multiple-adjusted odds ratio, 2.96; 95% confidence interval, 2.56–3.42).
These findings suggest that use of telephonic nurse management programs may improve care of women with GDM during and after pregnancy.
From the Division of Research (A.F., M.M.H., and T.P.), Kaiser Permanente Northern California, Oakland, and the Regional Perinatal Service Center (J.C. and Y.M.C.), Santa Clara, CA; and the Departments of Medicine and Obstetrics and Gynecology (C.K.), Ann Arbor, MI.