Associations of dietetic management with maternal and neonatal health outcomes in women diagnosed with gestational diabetes: a retrospective cohort study

Abstract

How to cite this article Absalom G., Zinga J., Margerison C., van der Pligt P. (2019) Associations of dietetic management with maternal and neonatal health outcomes in women diagnosed with gestational diabetes: a retrospective cohort study. J Hum Nutr Diet. 32, 728-736 https://doi. AbstractBackground: In 2010, the recommended diagnostic thresholds for gestational diabetes mellitus (GDM) were amended, which has increased GDM diagnoses, as well as pressure on the services involved in GDM management, specifically impacting dietetic workloads. The present study examined the associations between dietetic intervention in women with GDM and maternal and neonatal health outcomes. Methods: The present study involved 1233 adult women with GDM who delivered at The Royal Women's Hospital (RWH), Melbourne, Australia, between July 2015 and May 2017. Retrospective data assessing GDM-care (therapy type, diagnosis time and model of care, maternal and neonatal health outcomes, and outpatient dietetic consultations) were retrieved from patient medical records. Unadjusted and adjusted linear and logistic regression were used to assess associations of GDM care dietetic intervention and GDM care and dietetic intervention with maternal and neonatal health outcomes. Results: Women receiving dietetic intervention had a decreased likelihood of infant admission to the neonatal intensive care unit or special care nursery than women who not receiving dietetic intervention [adjusted odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.22-0.75; P = 0.004). Women requiring pharmacotherapy were more likely to experience maternal complications (adjusted OR = 3.13, 95% CI = 2.23-4.41; P < 0.001) and had a greater number of dietetic consultations (b-coefficient = 0.28, 95% CI = 0.17-0.39; P < 0.001) compared to women managed through diet. Conclusions: Dietetic intervention plays a key role in optimising maternal and neonatal health outcomes for women with GDM. Exploring further the impact of dietetic intervention in women diagnosed with GDM is key with respect to understanding the optimal delivery of care for these women. The type and number of consultations included in a dietetic intervention should be investigated further.728

Medical nutrition therapy for gestational diabetes mellitus in Australia: What has changed in 10 years and how does current practice compare with best practice?

“…Identifying these barriers is the first step in developing tailored implementation strategies 29‐32 . Lack of dietetic staffing has been reported as one of the greatest barriers to GDM guideline implementation in several studies given the frequency of visits recommended (one initial visit and two or more reviews) 33–35 . Given the rising rates of GDM globally and concurrent increases in clinical workload, this is not surprising 11,12 .…”

“… 29 , 30 , 31 , 32 Lack of dietetic staffing has been reported as one of the greatest barriers to GDM guideline implementation in several studies given the frequency of visits recommended (one initial visit and two or more reviews). 33 , 34 , 35 Given the rising rates of GDM globally and concurrent increases in clinical workload, this is not surprising. 11 , 12 However, despite these challenges, several Australian studies have developed models of care aimed at increasing provision of evidence‐based MNT for GDM.…”

Dietary Patterns and Dietary Adaptations in Women With and Without Gestational Diabetes: Evidence From the Growing Up in New Zealand Study

“…In a group of Canadian women, 17 with GDM and 27 with normal glucose tolerance, Morisset et al (2014) demonstrated that a multidisciplinary medical and nutrition intervention, including counselling from a registered dietitian, was effective in the achieving prescribed macronutrient distributions and controlling gestational weight gain in women with GDM. Other studies have demonstrated further benefits of dietetic input in women with GDM, including reduced insulin use and improvements in glycated haemoglobin [69] and reduced likelihood of infant admission to neonatal intensive care or special care units [70].…”

New Zealand women’s experiences of managing gestational diabetes through diet: a qualitative study

“…The structure of these clinics varies across New Zealand regions but typically include a diabetes physician, obstetrician, diabetes midwife or diabetes specialist nurse and a dietitian. Although studies have found dietetic input to be associated with positive outcomes for women with GDM [ 23 – 25 ] surveys of dietetic practice have identified some inconsistencies in the services provided and recommendations made to women with GDM with some women with GDM not seeing a dietitian at all [ 26 – 29 ]. Furthermore, women are exposed to nutrition messages from several sources which may be inconsistent or incomplete [ 30 – 33 ] leading to confusion about what to do and a lack of confidence in recommendations [ 34 , 35 ].…”