Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management Protocol

Abstract

Background. Diabetes in pregnancy is associated with an increased risk to the woman and to the developing fetus. Currently, there is no consensus on the optimal management strategies for the follow-up and the timing of delivery of pregnancies affected by gestational and pregestational diabetes, with different international guidelines suggesting different management options. Materials and Methods. We conducted a retrospective cohort study from January 2017 to January 2021, to compare maternal and neonatal outcomes of pregnancies complicated by gestational and pregestational diabetes, followed-up and delivered in a third level referral center before and after the introduction of a standardized multidisciplinary management protocol including diagnostic, screening, and management criteria. Results. Of the 131 women included, 55 were managed before the introduction of the multidisciplinary management protocol and included in group 1 (preprotocol), while 76 were managed according to the newly introduced multidisciplinary protocol and included in group 2 (after protocol). We observed an increase in the rates of vaginal delivery, rising from 32.7% to 64.5% (<0.001), and the rate of successful induction of labor improved from 28.6% to 86.2% ( P < 0.001 ). No differences were found in neonatal outcomes, and the only significant difference was demonstrated for the rates of fetal macrosomia (20% versus 5.3%, P : 0.012). Therefore, the improvements observed in the maternal outcomes did not impact negatively on fetal and neonatal outcomes. Conclusion. The introduction of a standardized multidisciplinary management protocol led to an improvement in the rates of vaginal delivery and in the rate of successful induction of labor in our center. A strong cooperation between obstetricians, diabetologists, and neonatologists is crucial to obtain a successful outcome in women with diabetes in pregnancy.

Maternal and fetal outcome among gestational diabetes mellitus mothers treated at a tertiary care maternity hospital

“…Studies reveal that prophylactic insulin therapy will reduce the incidence of macrosomia among infants of GDM. 24 This is also in conformity with a previous study done in BIRDEM hospital, Bangladesh which included both pre GDM and GDM cases. 25 There was no neonatal mortality seen among mothers who had good blood sugar control and they were higher among poor and no control group of GDM mothers in our study and similar finding was also found in studies done in other countries.…”

Diabetes mellitus gestacional

“…Com base no estudo de Morlando et al (2021), na atualidade, não há consenso sobre as estratégias de manejo ideais, os testes pré-parto específicos, a frequência dos testes e o momento do parto de gestações afetadas por DMG e diabetes pré-gestacional, com diferentes diretrizes internacionais sugerindo diferentes opções de manejo.…”

“…Ao mesmo tempo, não foram encontradas diferenças nos resultados fetais e neonatais, além de uma redução significativa na ocorrência de macrossomia fetal. Morlando et al (2021) ainda discorrem que após a introdução do protocolo de manejo padronizado, a seleção das mulheres submetidas à LIO e a escolha do momento da LIO foram realizadas de forma mais efetiva, levando à redução da taxa de cesárea e melhor resposta à LIO. Isso também pode sugerir que construir uma equipe multidisciplinar e garantir uma forte cooperação e interação entre os obstetras, os diabetologistas e os neonatologistas é crucial para obter um resultado bem-sucedido em mulheres com diabetes na gravidez.…”