The Effects of Systematic Management on Maternal and
Neonatal Complications in Gestational Diabetes Subjects
Pitvara Panpitpat MNS*,
Thipaporn Tharavanij MD, MSc**, Charintip Somprasit MD***,
Chamnan Tanprasertkul MD***, Komsun Suwannarurk MD***
Affiliation :
* Department of Nursing, Thammasat University Hospital, Pathumthani, Thailand
** Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
*** Department of Obstetrics and Gynaecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Objective : To compare maternal and neonatal complications of gestational diabetes mellitus (GDM) between conservative
and systematic management.
Material and Method: This retrospective cohort study was conducted at Thammasat University Hospital, Thailand. GDM
subjects who were diagnosed and treated from October 2004 to March 2007 were classified as the conservative management
group (CMG). The participants who were diagnosed and treated from April 2007 to September 2009 were classified as the
systematic management group (SMG). SMG was ambulatory-managed per standard protocol by a multidisciplinary team
(physician, diabetes nurse case manager, nutritionist and pharmacologist).
Results : There were 87 and 118 subjects in CMG and SMG, respectively. Mean age and body mass index before pregnancy
in CMG and SMG were not statistical different. Oral glucose tolerance tests (50 and 100 gram) were similar in both groups.
The prevalence of GDM A2 was 57.5 and 55.1% in CMG and SMG, respectively. Mean gestational age at DM clinic
consultation and number of hospital admission of SMG was less than CMG (p<0.001). Neonatal hypoglycemic episode in
SMG was less than CMG (1.7 vs. 10.3; p = 0.007). Postpartum 75-gram glucose tolerance test appointments and percentages
of underwent in SMG were more than CMG (p<0.001). Other composite maternal and neonatal outcomes were not different
in either group.
Conclusion : Systematic management by a multidisciplinary team conducted according to a practical guideline has the
benefit of neonatal hypoglycemia reduction and hospital admission included postpartum DM surveillance increments.
Keywords : Systematic management, Gestational diabetes mellitus
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