Research
Obstetrics
Referral to telephonic nurse management improves outcomes in women with gestational diabetes

https://doi.org/10.1016/j.ajog.2012.04.019Get rights and content

Objective

We sought to determine whether, among women with gestational diabetes mellitus, referral to a telephonic nurse management program was associated with lower risk of macrosomia and increased postpartum glucose testing.

Study Design

There was medical center–level variation in the percent of patients referred to a telephonic nurse management program at 12 Kaiser Permanente medical centers, allowing us to examine in a quasi-experimental design the associations between referral and outcomes.

Results

Compared with women from centers where the annual proportion of referral nurse management was <30%, women who delivered from centers with an annual referral proportion >70% were less likely to have a macrosomic infant and more likely to have postpartum glucose testing (multiple-adjusted odds ratio, 0.75; 95% confidence interval, 0.57–0.98 and multiple-adjusted odds ratio, 22.96; 95% confidence interval, 2.56–3.42, respectively).

Conclusion

Receiving care at the centers with higher referral frequency to telephonic nurse management for gestational diabetes mellitus was associated with decreased risk of macrosomic infant and increased postpartum glucose testing.

Section snippets

Setting

Kaiser Permanente Northern California (KPNC) is an integrated health care delivery system that provides comprehensive medical services to >3 million members located in a 14-county region in Northern California. The sociodemographic characteristics of KPNC membership closely approximate the general population ethnically and socioeconomically and represent approximately 30% of the general population in the geographic areas covered.15

We used data from the KPNC GDM registry to identify women who

Results

At medical centers where the proportion of referrals to the telephonic nurse management program was >70% at the time of delivery, women were more likely to be ≥35 years of age, of nonwhite race-ethnicity, and obese. They were also more likely to have higher education and to have used glyburide during pregnancy. Women who were referred to the program also had slightly lower fasting, 1-hour, and 2-hour glucose values during the 3-hour OGTT (Table 1).

Compared with patients with GDM from medical

Comment

Our results suggest that women receiving care at the medical centers with higher referral to a telephonic nurse management program for women with GDM was associated with a reduced likelihood of having a macrosomic infant without increasing the risk of having a low-birth-weight infant. Referral to such a program was associated with an increase in postpartum glucose testing. Few evaluations of nurse management programs exist among women with GDM11 and none of these programs used telephone

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Cited by (47)

  • A telehealth lifestyle intervention to reduce excess gestational weight gain in pregnant women with overweight or obesity (GLOW): a randomised, parallel-group, controlled trial

    2020, The Lancet Diabetes and Endocrinology
    Citation Excerpt :

    Strengths of the GLOW trial include the large sample size, the ability to recruit a racially and ethnically diverse population, including Asian women (a group underrepresented in previous trials), and the identification and enrolment of potential participants very early in gestation. The intervention's use of telehealth, which has been shown to be successful in a health-care delivery setting to improve perinatal outcomes9 among women with gestational diabetes, is also a strength. This modality can be easily translatable to other clinical settings, one of the reasons being that cost per intervention participant was modest.

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Cite this article as: Ferrara A, Hedderson MM, Ching J, et al. Referral to telephonic nurse management improves outcomes in women with gestational diabetes. Am J Obstet Gynecol 2012;206:491.e1-5.

This study was supported in part by funds from the Translating Research into Action for Diabetes study, which was supported by the Centers for Disease Control and Prevention, grant number U58/CCU523525-03, and by grants number R18DK067334 and K23DK071552 from the National Institute of Diabetes and Digestive and Kidney Diseases.

The authors report no conflict of interest.

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