198538 Outcomes associated with a prenatal diabetes case management program in a suburban health department

Wednesday, November 11, 2009

Tanya L. Honderick, RN, MS, MPH, BC , Olathe Clinic and Administration, Johnson County Health Department, Olathe, KS
Ruth Wetta-Hall, RN, PhD, MPH, MSN , Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, KS
Melinda Hull, MSN, WHNP-BC , Olathe Clinic and Administration, Johnson County Health Department, Olathe, KS
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.

Learning Objectives:
Identify three complications associated with diabetic pregnancies. Explain the different types of birth outcomes used to test for differences. Differentiate pregnancy outcomes of a diabetic case management program compared to a standard prenatal case management program.

Keywords: Diabetes, Pregnancy Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Ruth Wetta-Hall, Assistant Professor in the Department of Preventive Medicine and Public Health at the University of Kansas School of Medicine-Wichita, is a registered nurse holding master degrees in nursing administration and public health, and a Ph.D. in Community Psychology. She teaches public health administration, performance improvement and program evaluation in the KUSM-W, MPH program. As the Director of Research and Evaluation Associates in Community and Clinical Health (REACH) Center , Ruth and her research team support the design and implementation of studies that serve clinical and community-based organizations. Ruth has 15 years of clinical experience in emergency and intensive care nursing, and more than five years of experience in quality improvement and Outcomes Research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.