Aims: Dietitians play a pivotal role in gestational diabetes mellitus (GDM) management, yet limited literature has assessed the impact of dietetic intervention in women with GDM. The aim of this study was to assess the associations between dietetic intervention and aspects of patient care in women diagnosed with GDM, and a range of maternal and neonatal outcomes.
Methods: This was a retrospective cohort study, of 1233 adult women diagnosed with GDM in a singleton pregnancy, who delivered at The Royal Women’s Hospital (RWH), between 1 July 2015 and 31 May 2017. A medical records audit determined the number of dietetic consultations per patient and obtained information regarding patient care (medical nutrition therapy or added pharmacotherapy, specialist diabetes clinic care or routine antenatal care), maternal outcomes (delivery method and birth interventions), and a range of neonatal outcomes. Adjusted linear and logistic regression was used to analyse associations.
Results: Women who required pharmacotherapy had a greater number of dietetic consultations compared to women managed solely with medical nutrition therapy (β-coef (95%CI) =0.28(0.17-0.39)), (p<0.001). Women managed in the specialist diabetes clinic had a greater number of dietetic consultations compared to women who were managed in routine antenatal care (β-coef (95%CI) =0.50(0.36-0.63)), (P<0.001). Women who received 1 or more dietetic consultations had a decreased likelihood of infant admission to the neonatal intensive care unit (NICU) or special care nursery (SCN) ([OR] 0.41, 95% CI 0.22-0.75; P=0.004), compared to women who did not receive any dietetic intervention. There were no associations between number of dietetic consultations and maternal outcomes (delivery method and birth interventions) or other neonatal health outcomes.
Conclusions: Dietetic intervention in GDM, as part of a comprehensive package of healthcare, is associated with fewer infant admissions to NICU or SCN. Further research should assess the impact of dietetic intervention, on optimising maternal and neonatal health in women with GDM.