Outcomes associated with a prenatal diabetes case management program in a suburban health department

Diabetes, a major U.S. public health concern, may complicate an otherwise healthy state of pregnancy, resulting in neonatal birth defects, miscarriage, premature or stillborn birth, low birth weight, or difficult delivery due to macrosomia. Diabetic women require special care to prevent poor pregnancy outcomes.

This three-year, historical cohort study compared the pregnancy outcomes of a diabetic case management program (N = 230) to a standard prenatal case management program (N=1,201) delivered in a suburban health department. The study was designed to test for differences in birth outcomes (birth weight, gestational age, fetal death, Apgar scores, or delivery mode) between the two groups using chi-square, student t-test, and between-subjects factorial ANOVA statistics.

Socioeconomic, medical, and behavioral risk factors were similar in both groups; however, diabetic clients were significantly older at enrollment (p<0.001). Diabetic clients in the high risk program had significantly more clinic visits (p<0.001). Birth outcomes including gestational age at birth, infant birth weight, APGAR scores at one and five minutes, and delivery mode were all similar in both groups. Moreover, there were no cases of fetal demise or early neonatal death in the high risk diabetic group.

Clients in the diabetic case management who enrolled during first trimester exceeded the ACOG goal of at least 13 prenatal visits during their pregnancies. This study suggests that clients receiving high risk/diabetic case management during their pregnancies can achieve outcomes comparable to non-diabetic women. Findings may have implications for prenatal care providers working with vulnerable populations.