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Nurses help pregnant women with gestational diabetes

Tuesday May 29, 2012
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Among women with gestational diabetes mellitus, referral to a telephone-based nurse management program was associated with lower risk of high baby birth weight and increased postpartum glucose testing, according to a study.

Investigators for the Kaiser Permanente Northern California Division of Research examined the associations between referral to telephone-based nurse consultation and outcomes in 12 Kaiser Permanente medical centers with variation in the percentage of patients referred to telephonic nurse management.

The investigators used data from the Kaiser Permanente Northern California GDM registry to identify women who had pregnancy complicated by GDM from 1997 through 2006. They restricted their cohort to women with GDM according to the National Diabetes Data Group criteria.

During the study period, 96% of all pregnant women without preexisting diabetes who delivered an infant were screened for GDM. The researchers excluded women who delivered multiple births due to their increased risk of perinatal complications. Overall, researchers identified 11,435 women with GDM at the 12 medical centers, of whom 44.5% were referred to the perinatal service center.

Compared with women from Kaiser Permanente medical centers where the annual proportions of referral to nurse management were less than 30%, women who delivered in medical centers with an annual referral proportion greater than 70% were less likely to have a high birth-weight infant without increasing the risk of having a low birth-weight infant, said Assiamira Ferrara, MD, PhD, the study’s lead author and a research scientist with the Kaiser Permanente Northern California Division of Research.

"In addition, they were more likely to have postpartum glucose testing, which leads to earlier identification and management of postpartum glucose intolerance or diabetes," Ferrara said.

The Kaiser Permanente Regional Perinatal Service Center, a nurse-based management program for women with GDM, "offers supplemental care via telephone counseling to women with high-risk pregnancies, including those complicated by GDM," said co-author Monique Hedderson, PhD, a research scientist with the Kaiser Permanente Northern California Division of Research.

The program includes a call center with 32 RNs and two registered dieticians who offer phone counseling seven days a week and address glucose monitoring and control, diet and physical activity. Nurses are available 24 hours a day, seven days a week, while dieticians are available to patients during business hours.

In addition to care provided by obstetricians, women referred to the center receive one to two counseling calls per week to help them manage their blood glucose levels during pregnancy. The center also sends a laboratory slip for postpartum glucose testing and a reminder telephone call if the screening test was not performed.

The study appears online in the June issue of the American Journal of Obstetrics and Gynecology. To read the abstract and access the study via subscription or purchase, visit http://bit.ly/LMNMqe.

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