Gestational diabetes mellitus (GDM) is associated with increased maternal and neonatal morbidity. The Diabetes Antenatal Care and Education (DANCE) clinic, an interdisciplinary service including obstetricians, endocrinologists, dieticians and diabetic educators was established in The Lyell McEwin Hospital, South Australia in 2012 to provide integrated care for GDM patients.
To compare neonatal outcomes in women with GDM on pharmacological intervention before and after the introduction of DANCE clinic.
A retrospective audit was performed on pregnant women who were diagnosed with GDM over a 12-month period in 2005 and in 2015 at the Lyell McEwin Hospital (LMH) and received pharmacological treatment (Insulin and/or Metformin). Patient’s demographics, treatment types, medication doses and foetal outcomes were noted. Fisher’s exact test was used to calculate the significance in results.
In 2005, 163 patients were diagnosed with GDM, and 39 (23.9%) required medication for their GDM management. Of the 39 pregnancies, there were 41 babies born. In 2015, 207 patients were diagnosed with GDM, and 95 (45.9%) patients required medications for GDM management. Of the 95 pregnancies, there were 96 babies born.
There was a statistically significant reduction in neonates requiring special care nursery (SCN) in 2015 post implementation of DANCE clinic (68.3% in 2005 vs 44.7% in 2015, p=0.0093).
There was a significant decrease in the rates of neonatal hypoglycaemia as well in 2015 (46.3% in 2005 vs 28.8% in 2015, p=0.0384).
There was however, no significant difference in the number of neonates with hypoglycaemia requiring dextrose infusion (31.6% in 2005 vs 39.3% in 2015, p=0.4113).
No significant difference in the rates of jaundice, infection, respiratory distress and foetal death were noted in 2015 compared to 2005.
The implementation of an integrated multidisciplinary antenatal care for women with GDM was associated with a reduction in neonatal hypoglycaemia and neonates requiring SCN.