Audit of outcomes of midwife-led gestational diabetes clinic — ASN Events
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Audit of outcomes of midwife-led gestational diabetes clinic (#306)

Nandini Shankara - Narayana 1 , Fleur Brennan 1 , Lyndal Tacon 1 , Samantha Hocking 1 , Roderick Clifton-Bligh 1 , Diana Learoyd 1 , Carol Palmisano 1 , Warick Giles 1 , Greg Fulcher 1
  1. Royal North Shore Hospital, St. Leonards, NSW, Australia

A retrospective audit was performed on 115 women with either pre-existing diabetes or gestational-diabetes (GDM) who delivered at Royal North Shore Hospital between July and December 2011. All women were reviewed at a specialist obstetric clinic (SOC) by an endocrinologist and if glycaemic targets were achieved by diet alone, were referred to a midwife led GDM clinic (m-GDMC) for ongoing management unless co-morbidities required review at SOC.

Study Demographics: The recorded ethnicities of the total study population were: Asian (45.6%), Caucasian (40%), Subcontinent (10.4%) and Middle Eastern (3%). Age distribution: <30 yrs (20.8%), 31-35yrs (44.8%), 36-40 yrs (25.6%), >40 yrs (8.8%). Pre-conception BMI: <20 (22.4%), 21-25 (43.2%), 26-30 (15.2%), 31-35 (8.8%) and >36kg/m2 (10.4%). Prior GDM was recorded in 14.7% and history of PCOS in 7.8%. Glycaemic management included insulin (32%), metformin (2.6%) and diet alone (65.2%). One patient took both metformin and insulin.

A sub-analysis of pregnancy outcomes was performed on patients managed with diet alone (n=75), attending m-GDMC (n=46) compared to SOC (n=29).

Delivery outcomes were similar in both clinics (m-GDMC vs. SOC): normal vaginal delivery 47.8% vs. 44.8%, instrumental delivery 21% vs. 25%; Caesarean section (CS) 30% vs. 31%, of which emergency CS 21.4% vs. 22%. Poor progression of labour was the commonest indication for CS in both populations.

Foetal outcomes were (m-GDMC vs. SOC): birth weight <2.0 kg 2.1% vs. 0%, 2.0 to 3.0kg 15.2% vs. 31%, 3.0 to 4.0kg 73.9% vs. 55.1%, >4kg 8.7% vs. 10.3%; incidence of hypoglycaemia 2% vs. 0%. Neonatal intensive care was required in 6(8.7% vs. 6.9%). APGAR scores were similar in both groups.

This audit demonstrates that pregnancy outcomes are similar in women with diet-controlled GDM, managed in either SOC or m-GDMC. This model of care potentially safely reduces the burden on specialist medical services. Following the audit, it was proposed that diet controlled GDM patients in SOC due to other co-morbidities could be managed by the diabetes educator.