To investigate the effectiveness of nursing case management on pregnant diabetics on maternal and fetal/neonatal outcomes using the following research questions: Is there a difference in outcomes for pregnant diabetic women who receive nursing case management services versus those who do not? Is there a difference in outcomes for pregnant diabetic women who receive weekly/biweekly face-to-face visits with the nursing case management versus those who receive weekly/biweekly telephone nursing case management?
A retrospective chart review of 93 pregnant women with preexisting diabetes and gestational diabetes mellitus (GDM) and their offspring.
A clinic setting and a private practice located within a large midwestern hospital.
Pregnant women with preexisting diabetes and GDM whose hemoglobin A1C was greater than 6.5% between January 2003 and June 2009.
Patients who received prenatal care between January 1, 2003 and June 2006 were the non-nursing case management group. Patients who received prenatal care in the private physician practice between July 2006 and June 2009 were the telephone nursing case management group. Patients who received care in the clinic between July 2006 and June 2009 were the face-to-face nursing case management group. A data collection sheet was created based upon maternal and neonatal outcomes related to diabetes in pregnancy. The independent variables were participation in either type of nursing case management. The maternal-dependent variables were A1C, preterm labor, and preeclampsia. The neonatal/fetal variables were macrosomia, respiratory distress syndrome, and plasma glucose level at birth.
A total of 93 pregnant women, 40 in the non-nursing case management group, 53 in the nursing case management group (31 in the face-to-face nursing case management group and 22 in the telephone nursing case management group) were included in the analysis. No significant differences between groups were observed, except the A1C significantly decreased (p = .037) for both groups from first trimester (non-nursing case management A1C = 9.27 [SD 2.6] and nursing case management A1C 8.96 [SD 1.7]) to the second trimester (non-nursing case management A1C = 7.32 [SD 1.8], nursing case management A1C = 7.10 [SD 1.3]), and the lower levels were sustained throughout the third trimester (non-nursing case management A1C = 7.16 [SD 2.1] and nursing case management A1C = 6.85 [SD 1.8]). However, the nursing case management group maintained tighter glycemic control during the second and third trimesters based upon the mean differences in A1C.
Conclusion/Implications for Nursing Practice
Either method of nursing case management is effective in assisting pregnant diabetics improve their A1C, an indication of improved glycemic control, which research shows contributes to improved birth outcomes. Future research needs to be done to determine if strategies for glycemic control can be maintained long term.