Background: Gestational diabetes mellitus (GDM) diagnosis has almost doubled in recent years with significant resource implications. Clinical practice guidelines recommend medical nutrition therapy provided by a dietitian as the cornerstone and first line treatment for GDM. Few studies have evaluated the impact of dietetic resourcing on ability to meet Nutrition Practice Guidelines (NPG’s) or maternal and fetal outcomes.
The aim of this clinical audit was to evaluate the impact of increased dietetic resourcing on achieving NPG’s of an initial appointment within one week of referral, and a minimum of three dietetic visits during pregnancy, and investigate the influence this had on selected on maternal and foetal outcomes.
Materials and Methods: A consecutive sample of women with newly diagnosed GDM using IADPSG criteria were audited between two time periods, December 2014 to March 2015 (2015 study cohort, n=139), and December 2015 to March 2016 (2016 study cohort, n=153). The participating hospital had increased dietetic resourcing after the 2015 study cohort to cope with the rising prevalence of GDM women. All information required were collected from routine hospital data sources.
Results: Increased resourcing was associated with improvements to the proportion of women being seen within a week of referral (53% vs 84%, p<0.001) and receiving at least 3 dietetic visits (69% vs 79% p=0.068). Pharmacotherapy was reduced from 41% in 2015 to 34% in 2016. After controlling for previous GDM history, ethnicity and BMI, a reduction in neonatal hypoglycaemia (15% 2015, 1% 2016) remained significant.
Conclusions: The increased dietetic resourcing improved women’s access to best practice care for education initiation and dietetic review and appears to have a positive influence on neonatal hypoglycaemia. Confirmation of these results in larger samples is required.