283: Improved outcomes for Hispanic patients with gestational diabetes using the Centering Pregnancy group prenatal care model

Abernathy, Mary Pell; Foxlow, Leslie A; Carter, Amy; Bastawros, Dina; Haas, David M.

doi:10.1016/j.ajog.2012.10.448

Cited by 5 publications

(2 citation statements)

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“…On reviewing the contemporary literature, we found only a few published studies of antenatal group clinics for gestational diabetes [34,35]. However, a common thread was that they all reported improvements in patient satisfaction, knowledge, empowerment, and other outcomes.…”

Section: Discussionmentioning

confidence: 99%

The GooD Pregnancy Network: An Alternative Approach for Gestational Diabetes

Ikomi

Mannan

2022

BioMed

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Basildon and Thurrock University Hospital in the East of England region of the United Kingdom (UK) witnessed rapidly increasing numbers of pregnant women with diabetes, causing overburdened specialist clinics, poorer patient experience and worsening clinical outcomes. This prompted the multidisciplinary team’s remodelling of care pathways, launching the General ownership of Diabetes (GooD) Pregnancy Network in 2014. Contrary to the conventional limitation of care to specialist diabetes antenatal clinics, this novel initiative highlights the contemporary necessity to equip and empower all maternity stakeholders to deliver the basic care of gestational diabetes (GDM). It strategically connects a Midwife Tele-Clinic “hub” to Educating Gestational Diabetics Group Sessions (EGGS) and standard antenatal clinics. Patients were key partners, regularly participating in feedback surveys and promoting public awareness by co-producing local newspaper articles that served up their stories as case studies. Furthermore, the EGGS “faculty” includes a former GDM patient whose video testimony has inspired almost 2000 patients and their families, aiming to foster long term healthy lifestyle changes. The final summative evaluation in November 2019 showed the new culture of wider consciousness has shortened the “diagnosis to first consultation” intervals and eliminated overbooked specialist clinics (none since January 2016), without further worsening of clinical outcomes. It also boosted research recruitment and avoided additional running costs to the tune of GBP 66,384 a year.

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Section: Discussionmentioning

confidence: 99%

The GooD Pregnancy Network: An Alternative Approach for Gestational Diabetes

Ikomi

Mannan

2022

BioMed

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“…More recently, Schlachter, Ahern, and Brown (2013) reported significant improvement in pretest scores (75%) to posttest scores (96%) and patient satisfaction of 96% after patients attended a 2-hour class developed specifically for gestational diabetics. In addition, Schellinger et al (2013) reported improved outcomes for Hispanic patients with GD who attended a Centering Pregnancy group program adapted for this high-risk population. Finally, Frazzitta, Anderson, and Egan (2013) described postpartum diabetes screening rates for gestational diabetics using a group format that met for one session, 6-8 weeks after giving birth.…”

Section: Group Care For Gestational Diabetics: Literaturementioning

confidence: 99%

The Gestational Diabetes Group Program

Nasso¹,

McCloskey²,

Nordquist³

et al. 2018

J Perinat Educ

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The purpose of the Gestational Diabetes Group Program (GDGP) was to provide patients with diabetes self-management education that occurs in a supportive, prenatal group care setting. The Centering Pregnancy Interdisciplinary Model of Empowerment and the Chronic Care Model guided the program. The pilot project took place at an urban clinic that cares for a diverse, underserved population. The GDGP, a series of four prenatal group sessions after the diagnosis of gestational diabetes and one postpartum group, used an interprofessional/interdisciplinary approach to care with the groups cofacilitated by certified nurse-midwives, certified diabetes nurse-educators, and other community partners. The program was able to show statistically significant changes in knowledge and empowerment, optimal pregnancy outcomes, and high patient satisfaction.

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Diabetes Group Prenatal Care

Carter,

Thayer,

Paul

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To estimate the effect of diabetes group prenatal care on rates of preterm birth and large for gestational age (LGA) among patients with diabetes in pregnancy compared with individual diabetes prenatal care. DATA SOURCES: We searched Ovid Medline (1946–), Embase.com (1947–), Scopus (1823–), Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. METHODS OF STUDY SELECTION: We searched electronic databases for randomized controlled trials (RCTs) and observational studies comparing diabetes group prenatal care with individual care among patients with type 2 diabetes mellitus or gestational diabetes mellitus (GDM). The primary outcomes were preterm birth before 37 weeks of gestation and LGA (birth weight at or above the 90th percentile). Secondary outcomes were small for gestational age, cesarean delivery, neonatal hypoglycemia, neonatal intensive care unit admission, breastfeeding at hospital discharge, long-acting reversible contraception (LARC) uptake, and 6-week postpartum visit attendance. Secondary outcomes, limited to the subgroup of patients with GDM, included rates of GDM requiring diabetes medication (A2GDM) and completion of postpartum oral glucose tolerance testing (OGTT). Heterogeneity was assessed with the Cochran Q test and I 2 statistic. Random-effects models were used to calculate pooled relative risks (RRs) and weighted mean differences. TABULATION, INTEGRATION, AND RESULTS: Eight studies met study criteria and were included in the final analysis: three RCTs and five observational studies. A total of 1,701 patients were included in the pooled studies: 770 (45.3%) in diabetes group prenatal care and 931 (54.7%) in individual care. Patients in diabetes group prenatal care had similar rates of preterm birth compared with patients in individual care (seven studies: pooled rates 9.5% diabetes group prenatal care vs 11.5% individual care, pooled RR 0.77, 95% CI, 0.59–1.01), which held for RCTs and observational studies. There was no difference between diabetes group prenatal care and individual care in rates of LGA overall (four studies: pooled rate 16.7% diabetes group prenatal care vs 20.2% individual care, pooled RR 0.93, 95% CI, 0.59–1.45) or by study type. Rates of other secondary outcomes were similar between diabetes group prenatal care and individual care, except patients in diabetes group prenatal care were more likely to receive postpartum LARC (three studies: pooled rates 46.1% diabetes group prenatal care vs 34.1% individual care, pooled RR 1.44, 95% CI, 1.09–1.91). When analysis was limited to patients with GDM, there were no differences in rates of A2GDM or postpartum visit attendance, but patients in diabetes group prenatal care were significantly more likely to complete postpartum OGTT (five studies: pooled rate 74.0% diabetes group prenatal care vs 49.4% individual care, pooled RR 1.58, 95% CI, 1.19–2.09). CONCLUSION: Patients with type 2 diabetes and GDM who participate in diabetes group prenatal care have similar rates of preterm birth, LGA, and other pregnancy outcomes compared with those who participate in individual care; however, they are significantly more likely to receive postpartum LARC, and those with GDM are more likely to return for postpartum OGTT. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021279233.

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283: Improved outcomes for Hispanic patients with gestational diabetes using the Centering Pregnancy group prenatal care model

Cited by 5 publications

References 0 publications

The GooD Pregnancy Network: An Alternative Approach for Gestational Diabetes

The GooD Pregnancy Network: An Alternative Approach for Gestational Diabetes

The Gestational Diabetes Group Program

Diabetes Group Prenatal Care

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