Maternal and neonatal health outcomes following the implementation of an innovative model of nurse practitioner-led care for diabetes in pregnancy

Aim. To investigate maternal and neonatal outcomes following implementation of a nurse practitioner-led model of care for diabetes in pregnancy. Background. Diabetes in pregnancy increases the risk of adverse health outcomes in mothers and infants. The management of diabetes in pregnancy is crucial to reduce poor outcomes. Design. Uncontrolled before-after intervention study. Methods. International Classification of Diseases codes were used to identify pregnancies suspected of being complicated by diabetes. Demographic, health, diabetes and maternity data were extracted from hospital records. Adverse maternal and neonatal outcomes were compared pre- (2003–2006) and postintervention (2010–2011). Adjusted relative risks (aRR) were calculated using the glm command in Stata. Results. A total of 261 pregnancies were included: 112 pre-intervention and 149 managed under the nurse practitioner-led model. There were 37 women with pre-existing diabetes (26 T1DM, 11 T2DM) and 195 with gestational diabetes. Referrals to dieticians and diabetes educators increased, while referrals to physicians decreased. There was no decrease in the risk of adverse maternal outcomes for all women with DIP or women with GDM. However, there was a 24% decrease in adverse neonatal outcomes overall and a 40% decrease among infants of women with gestational diabetes. Conclusion. The study demonstrated that nurse practitioner-led models of care for diabetes in pregnancy are feasible. The findings suggest that the model reduced adverse neonatal outcomes. By improving information provision, support and care coordination, the model is particularly valuable in rural areas, where access to medical specialists is often restricted.