396: Medication adherence in women with gestational diabetes and its effect on pregnancy outcomes

Abstract

OBJECTIVE: Treatment of gestational diabetes (GDM) is associated with improved pregnancy outcomes. Obstacles to taking prescribed medications can lead to non-compliance. The objective was to determine the challenges that lead to low medication adherence and whether this increases the rate of adverse pregnancy outcomes in women with GDM. STUDY DESIGN: A prospective, observational study was performed of women with GDM treated with metformin, glyburide or insulin at a tertiary care center. Women greater than 16 weeks gestation and treated for a minimum of 2 weeks were included. Women with pre-DM were excluded. Women completed a validated survey, MMAS-8 (low: score <6 and high: score 7-8), to identify women with low and high medication adherence. Information resulting in medication compliance was collected. The primary outcome was neonatal birth weight >4,000g. Secondary outcomes included factors with medication adherence, adherence rates for each medication and neonatal outcomes. RESULTS: Of 79 women who met study criteria, 42 reported high and 37 reported low adherence. Birth weight >4,000g were similar in each group, (low: 16.2% vs. high: 7.1%, p ¼ 0.292). Women prescribed metformin had the highest rate of high adherence (38.1%) and women on glyburide had the highest rate of low adherence (46%). The rate of neonatal hypoglycemia was significantly higher in women with low adherence compared to high adherence, (low: 70.3% vs high 42.9%, p ¼ 0.023). There were similar rates of induction of labor, cesarean section, NICU admissions, and neonatal respiratory complications. There were no cases of shoulder dystocia, Erb's palsy, or major neonatal morbidities. Obstacles to medication adherence were documented in 14% of women including prescription error, insurance difficulties and delay in dispensing the medications. Adverse effects to medication were reported in 10-20% of women. CONCLUSION: Although there were no differences in neonatal birthweight between groups, low medication adherence was associated with neonatal hypoglycemia. Challenges to compliance with prescribed medications occurred in 14% of GDM women and up to 1 in 5 women reported a medication side effects. Further studies are needed to investigate patient-specific and system-level strategies to improve medication adherence in women with GDM.

Adherence to Clinical Practice Guideline Recommendations in Women with Gestational Diabetes and Associations with Maternal and Infant Health—A Cohort Study

“…As with all treatment, adherence to the advice given is key [ 3 ]. Among women with GDM, moderate adherence has been reported for the dietary and pharmacological recommendations, including oral hypoglycaemics and insulin [ 4 , 5 ]. Some studies have found an association between achieving the appropriate gestational weight gain and high adherence to pharmacological guidelines for the management of GDM and improved pregnancy health outcomes [ 5 , 6 ].…”

“…Among women with GDM, moderate adherence has been reported for the dietary and pharmacological recommendations, including oral hypoglycaemics and insulin [ 4 , 5 ]. Some studies have found an association between achieving the appropriate gestational weight gain and high adherence to pharmacological guidelines for the management of GDM and improved pregnancy health outcomes [ 5 , 6 ]. Infants of women with high adherence to pharmacological treatments for GDM had lower rates of neonatal hypoglycaemia compared to infants of women with low adherence [ 5 ].…”

“…Some studies have found an association between achieving the appropriate gestational weight gain and high adherence to pharmacological guidelines for the management of GDM and improved pregnancy health outcomes [ 5 , 6 ]. Infants of women with high adherence to pharmacological treatments for GDM had lower rates of neonatal hypoglycaemia compared to infants of women with low adherence [ 5 ]. Good adherence to gestational weight gain recommendations among women with GDM has been associated with decreased risk of caesarean section, an infant born large-for-gestational-age (LGA), macrosomia, and neonatal hypoglycaemia [ 6 ].…”