Referral to telephonic nurse management improves outcomes in women with gestational diabetes.

OBJECTIVE: We sought to determine whether, among women with gestational diabetes mellitus, referral to a telephonic nurse management program was associated with lower risk of macrosomia and increased postpartum glucose testing. STUDY DESIGN: There was medical center-level variation in the percent of patients referred to a telephonic nurse management program at 12 Kaiser Permanente medical centers, allowing us to examine in a quasi-experimental design the associations between referral and outcomes. RESULTS: Compared with women from centers where the annual proportion of referral nurse management was <30%, women who delivered from centers with an annual referral proportion >70% were less likely to have a macrosomic infant and more likely to have postpartum glucose testing (multiple-adjusted odds ratio, 0.75; 95% confidence interval, 0.57-0.98 and multiple-adjusted odds ratio, 22.96; 95% confidence interval, 2.56-3.42, respectively). CONCLUSION: Receiving care at the centers with higher referral frequency to telephonic nurse management for gestational diabetes mellitus was associated with decreased risk of macrosomic infant and increased postpartum glucose testing.

The risk of large for gestational age across increasing categories of pregnancy glycemia.

OBJECTIVE: We sought to estimate the risk of large for gestational age (LGA) across categories of glucose tolerance. STUDY DESIGN: In a cohort of 89,141 participants, women without gestational diabetes mellitus (GDM) were categorized by their screening and diagnostic test results; those with GDM were categorized as meeting the National Diabetes Data Group or only the American Diabetes Association (ADA) criteria. Multivariable logistic regression models estimated the risk of LGA; screening values 5.5-6.0 mmol/L comprised the referent. RESULTS: In women without GDM, the odds ratio for LGA was 1.89 (95% confidence interval [CI], 1.45-2.45) for fasting, 1.57 (95% CI, 1.31-1.89) for 1-hour, 1.60 (95% CI, 1.33-1.93) for 2-hour, and 1.62 (95% CI, 1.23-2.14) for 3-hour values meeting the ADA time point-specific thresholds. CONCLUSION: For GDM identified in a 2-step procedure, our findings support the use of isolated abnormal fasting values according to the ADA threshold in identifying women who could benefit from treatment.