Antenatal models of care for women with gestational diabetes mellitus: Vignettes from an international meeting
| Autor: | Alison Barry, Sarah A Price, Vincent W. Wong, Ana McCarthy, Tara Jones, Thomas J. Cade, Catharine McNamara, Linda Burcher, David Simmons, Emily Gianatti, Jeff R. Flack, Ruth C. E. Hughes, Cathy Latino, David McIntyre, Marina Mickelson, Christopher J. Nolan, Rohit Rajagopal, Maryam Sina |
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| Rok vydání: | 2020 |
| Předmět: |
Blood Glucose
medicine.medical_specialty Telemedicine Referral 030209 endocrinology & metabolism Telehealth 03 medical and health sciences 0302 clinical medicine Pregnancy Health care medicine Humans 030212 general & internal medicine Medical nutrition therapy business.industry Blood Glucose Self-Monitoring Australia Obstetrics and Gynecology General Medicine medicine.disease Gestational diabetes Diabetes Gestational Family medicine Female business New Zealand Patient education |
| Zdroj: | Australian and New Zealand Journal of Obstetrics and Gynaecology. 60:720-728 |
| ISSN: | 1479-828X 0004-8666 |
| Popis: | Background Gestational diabetes (GDM) is one of the commonest pregnancy complications and is placing an increasing burden on diabetes and obstetric resources. Aims To describe different antenatal models of care that have developed to address the increasing proportion of pregnancies complicated by GDM. Materials and methods Narrative review with thematic analysis from 15 volunteer antenatal diabetes in pregnancy services from Australia and New Zealand identified through a national diabetes organisation. Main outcomes were approaches to patient education, medical nutrition therapy (MNT), ongoing management and escalation of therapy for women with GDM. Results All clinics provided at least one group education and one MNT session within 1-2 weeks of GDM diagnosis. Women from culturally and linguistically diverse communities usually required 1:1 education. Ongoing management of women with GDM was through either all women being seen in the GDM clinic, a step-up approach (ongoing management by the primary antenatal team with diabetes team referral if self-blood glucose monitoring (SBGM) or insulin therapy dosage criteria are reached) or step-down approach (ongoing management by the diabetes team with step-down to the primary antenatal team if SBGM criteria are reached). Telehealth was used to reduce the burden of clinic attendance, particularly in rural areas. Conclusions Increasing numbers, earlier diagnoses, the need to provide care to women in rural, remote areas, and cultural/language differences, have generated a range of different antenatal models of care, allowed better workload accommodation and probably reduced costs. Randomised controlled trials of different models of care, with associated health economic analyses, are urgently needed. |
| Databáze: | OpenAIRE |
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