General self-efficacy and social support as mediators of the association between perceived stress and quality of life among rural women with previous gestational diabetes mellitus.

To explore the association between perceived stress and quality of life (QoL) and the mediating role of general self-efficacy and social support in this association. Gestational diabetes mellitus (GDM) is one of the most common metabolic diseases suffered by pregnant women. Women with previous GDM may experience more medical-related stress and have a lower QoL than those without it. A multisite correlational study. Four hundred sixty-five women with previous GDM living in rural areas in China participated in this study from November 2017 to June 2019. The participants completed a set of self-reported socio-demographic questionnaires, the Perceived Stress Scale, the General Self-Efficacy Scale, the Social Support Rating Scale and the World Health Organization QoL assessment (Brief version). STROBE checklist was used as the guideline for this study. The mean QoL score was 13.97 (SD 2.07) for physical health, 13.75 (SD 1.98) for psychological health, 14.96 (SD 1.99) for social relations and 12.49 (SD 1.74) for environmental conditions. About 43.9% of women with previous GDM reported increased stress, which was negatively correlated with each of these QoL domains. Yet, the negative effect of perceived stress on QoL could be completely or partly mediated by better social support or general self-efficacy among this population. Nearly half of the women in the study living in rural China reported increased stress after delivery, and there is room to improve QoL in the environmental domain among women with previous GDM. Increasing general self-efficacy or social support can help these women avoid the negative effects of perceived stress on their QoL. These findings suggest that healthcare providers need to be cognizant of the importance of self-efficacy and social support for women with previous GDM in both enhancing QoL and reducing the negative impact of perceived stress on QoL.

Perspectives on Barriers and Facilitators in Caring for Women with Gestational Diabetes in Rural Appalachia.

PURPOSE: The purpose of this study was to explore perspectives of healthcare providers in rural Appalachia who care for pregnant women with gestational diabetes, including management facilitators and barriers. STUDY DESIGN AND METHODS: Qualitative study with interviews and thematic analysis. Thematic analysis was conducted using the sort and sift method after inductive content analysis with open coding, identifying categories, and abstraction. RESULTS: Twenty-one advanced practice nurses and 10 physicians participated in the study. Three themes were identified: rural healthcare challenges including limited resources and lack of adherence to recommendations, cultural influences including normalization of diabetes and food culture, and collaborative care including accessible resources and patient motivation. CLINICAL IMPLICATIONS: The themes provide insight into the perceived barriers and facilitators of healthcare providers caring for women with gestational diabetes in rural Appalachia. Consistent, evidence-based communication with cultural consideration supports effective education and care of women with gestational diabetes. Healthcare providers' knowledge of local resources, accessible electronic medical records, and communication among the various team members enhance collaboration in diabetic management in the rural setting.

Effects of nutritional nursing intervention based on glycemic load for patient with gestational diabetes mellitus.

OBJECTIVES: To determine the effects of nutritional nursing intervention based on glycemic load (GL) for patients with gestational diabetes mellitus. MATERIAL AND METHODS: One hundred thirty-four patients diagnosed with gestational diabetes mellitus at our hospital were selected from March 2015 to March 2017 and randomly divided into the observation (n = 67) and control groups (n = 67). All of the patients in the observation and control groups received conventional nutritional nursing. In addition, the patients in the observation group received nutritional nursing intervention based on GL. The changes in blood glucose levels and pregnancy outcomes were compared between the two groups after intervention. RESULTS: There were significant differences in fasting blood glucose (FBG) and the 2h postprandial glucose (2hPG) levels between the two groups (P < 0.05). There was a lower incidence of premature delivery, fetal macrosomia, eclampsia, preg- nancy hypertension syndrome, and fetal distress in the observation group. CONCLUSIONS: Nutritional nursing intervention based on GL is more effective than traditional nutritional nursing for patients with gestational diabetes, and can effectively control the blood glucose level, reduce the incidence of pregnant complica- tions, and improve the pregnancy outcome. Thus, nutritional nursing intervention based on GL deserves to be popularized.

Nursing management of gestational diabetes mellitus in Ghana: Perspectives of nurse-midwives and women.

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is observed in the beginning of, or first acknowledged during pregnancy. The prevalence of GDM is estimated to be approximately 15% globally and is expected to increase due to growing numbers of overweight and obesity in women in their reproductive age. The nursing management of GDM in terms of lifestyle modifications (exercise, diet and nutrition) and the taking of diabetes medication, if required, and adherence thereto is crucial to prevent maternal and neonatal-perinatal complications. This qualitative study therefore aimed to explore and describe the experiences of women regarding the nursing management they received after being diagnosed with GDM; and the perceptions of nurse-midwives on their nursing management of GDM in Ghana. SETTING: This study was conducted in the military health institutions in Ghana, which includes one hospital and nine satellite clinics referred to as Medical Reception Stations providing antenatal and postnatal care to both military as well as civilian patients. Research on GDM in Ghana is extremely limited. DESIGN: We used a descriptive phenomenological approach to conduct 15 unstructured individual interviews with women that have been diagnosed with GDM (n = 7) and nurse-midwives (n = 8) providing nursing management of GDM during a six months period (December 2014 to May 2015). Audio-recorded data was transcribed, coded and analyzed using an adapted version of Tesch's eight steps for coding. PARTICIPANTS: Seven (n = 7) women between 28 and 45 years of age, with 1 to 3 offspring each, participated. Most women (n = 5) did not have a family history of diabetes. The eight (n = 8) nurse-midwives that participated were between 32 and 50 years old with between 2 and 12 years of experience. FINDINGS: Participants in this study reported similar issues that could assist in better management of GDM. The majority of participants indicated the need for education on GDM, but both women and nurse-midwives acknowledged that this education is hugely lacking. Participants generally felt that emotional support for women is critical and it was included in the nursing management of GDM. Both groups of participants acknowledged that involving women and their significant others in the nursing management of GDM is important. Cultural and socio-economic issues, such as cultural beliefs that clashed with diabetic diets, lack of financial and social grants and limited nurse-midwifery staff were mentioned by both groups to affect the nursing management of GDM. KEY CONCLUSIONS: The results demonstrate that, despite the reported challenges experienced by nurse-midwives and women, it was evident that the aim of nurse-midwives was to manage GDM as optimally as possible for women diagnosed with GDM, while considering the constraints established in the results. The challenges identified, specifically in terms of lack of education and cultural and socio-economic issues that affect the quality of and adherence to the nursing management of GDM, need to be addressed in order to optimize care for women diagnosed with GDM in Ghana. IMPLICATIONS FOR PRACTICE: Based on our findings, recommendations are provided that can assist nurse-midwives and other health practitioners to provide comprehensive nursing management to women that have been diagnosed with GDM.

Lived experience of blood glucose self-monitoring among pregnant women with gestational diabetes mellitus: a phenomenological research.

AIMS AND OBJECTIVES: To explore and describe lived experience of blood glucose self-monitoring among pregnant Thai women with gestational diabetes mellitus. BACKGROUND: Self-monitoring of blood glucose is an essential practice among pregnant women with diabetes to prevent complications in pregnancy and the newborn infant. DESIGN: Phenomenological research was employed to understand lived experiences in glycemic control. METHODS: Thirty participants were approached and interviewed using a semistructured interview guides. Qualitative data were analysed following Colaizzi's method. RESULTS: The findings revealed three themes: being worried about diabetes and blood testing, trying to control it and being patient for the child. Their worry comprised three dimensions: (1) wondering about the impacts of diabetes on the child, (2) concern about maternal health and (3) being worried about doing blood test. Trying to control diabetes was composed of three dimensions: (1) learning to test blood glucose, (2) being afraid of elevated blood sugar and (3) being aware of what to eat. Being patient for the child was composed of three dimensions: (1) overcoming food desires, (2) tolerating the fingerprick pain and (3) satisfaction with the outcomes. CONCLUSIONS: Women with gestational diabetes experienced being worried and afraid regarding blood glucose self-monitoring; however, they could overcome and tolerate this with some difficulties. RELEVANCE TO CLINICAL PRACTICE: These findings can be used to guide nursing practice in assessment of perception and response towards blood glucose self-monitoring in order to improve achievement of a good glycaemic control among pregnant women with gestational diabetes mellitus.

Postpartum Care for Women with Gestational Diabetes.

PURPOSE: To assess postpartum gestational diabetes mellitus (GDM) practice patterns of providers in a large, tertiary care hospital. A retrospective review of medical records for women with GDM receiving postpartum care in 2012 was conducted to estimate the percentage who received a postpartum visit, glucose testing, and preventive follow-up care. STUDY DESIGN AND METHODS: A sample of 97 charts was reviewed. Pearson's chi-squared tests and Fisher's exact test were used, as appropriate, to examine differences in documented care by race/ethnicity, insurance type, and type of medical provider. RESULTS: Within the system of study, 53 of 97 women (55%) with GDM had a documented postpartum visit, with disparities by race/ethnicity and insurance type, and 18 (19%) had a documented oral glucose tolerance test after 6 weeks postpartum. Most providers routinely documented interacting with patients around infant feeding, family planning, and emotional status, but fewer documented providing specific care to help patients manage future diabetes risk, with advance practice nurses significantly more likely than physicians to document some aspects of preventive care. CLINICAL IMPLICATIONS: Postpartum GDM care could be improved by educating providers on the current postpartum GDM standard of care and use of the 5 A's framework for health promotion; prompting providers to order appropriate screenings and document the 5 A's; coordinating follow-up glucose screening and behavioral management with the postpartum visit and subsequent family planning visits; notifying primary care providers and pediatricians of the GDM diagnosis to ensure continuity of care; and referring to allied healthcare providers for intensive behavior change support.

Antenatal management of gestational diabetes mellitus can improve neonatal outcomes.

OBJECTIVE: Pregnancies complicated with gestational diabetes mellitus (GDM) are at a higher risk for caesarean and instrumental deliveries as well as adverse neonatal outcomes such as fetal overgrowth, hypoglycaemia and neonatal intensive care admission. Our primary objective was to describe neonatal outcomes in a sample that included term infants of both GDM mothers and mothers with normal glucose tolerance (NGT). DESIGN AND SETTING: this cross-sectional study included 599 term babies born between September and October 2010 at Royal Prince Alfred Hospital, Sydney, Australia. Maternal and neonatal data were collected from medical records and a questionnaire. Glycaemic control data was based on third trimester HbA1c levels and self-monitoring blood glucose levels (BGL). Univariate associations between GDM status and maternal demographic factors, as well as pregnancy outcomes, were estimated using χ(2) tests and t-tests, as appropriate. FINDINGS: of 599 babies, 67(11%) were born to GDM mothers. GDM mothers were more likely to be overweight/obese and of Asian ethnicity. Good glycaemic control was achieved in most GDM mothers. GDM babies were more likely to have been induced (p=0.013) and delivered earlier than non-GDM mothers (p<0.001), and they were also more likely to be breastfed within one hour of birth. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: in this study, GDM infants were more likely to be induced and delivered earlier but otherwise they did not have significantly different neonatal outcomes compared to infants of NGT mothers. This can be attributed to the good GDM control by lifestyle modification and insulin if necessary. The role of labour induction in GDM pregnancies should be further investigated. Midwives have an important role in maternal education during pregnancy and in the postnatal period.

Results of the Optimizing Outcomes in Women with Gestational Diabetes Mellitus and Their Infants, a Cluster Randomized, Controlled Pilot Study: Lessons Learned.

The purpose of this pilot study was as follows: Aim I was to determine the feasibility of the intervention, including its acceptability, and tofurther refine intervention materials and study procedures including recruitment, enrollment, intervention, retention, and data collection. Aim 2 was to test the initial effects of the intervention on the primary outcome of fasting blood glucose and secondary outcomes including metabolic, clinical, adiposity, health behavior, and self-efficacy outcomes in women. Aim 3 examined infant feeding. Infant weight and adiposity growth are discussed in this manuscript. The intervention group received the Phase I intervention, which included 14 classes, each lasting 60 minutes, with the first class delivered during pregnancy on the benefits of breastfeeding for maternal metabolic control andfor infant health. The classes resumed 6 weeks postpartum and were delivered weekly. The Phase II intervention included 3 monthly classes, each lasting 60 minutes, during which the interventionist facilitated a group discussion and assisted the women with problems related to breastfeeding, nutrition, or exercise. Results demonstrated that 100 women were enrolled in the study; however, secondary to the majority of women returning to work part-time or full-time, the retention for the intervention and data collection was poor. In addition, statistical significancefor the primary outcomes was not achieved. However, women made some changes in adiposity and health behaviors, and infants made changes in adiposity growth. Both lessons learned and future research are discussed.

Norwegian nurse-midwives' perspectives on the provision of antenatal diabetes care in an outpatient setting: A qualitative study.

BACKGROUND: There is limited research related to nurse-midwives' accounts of their provision of antenatal diabetes care in hospital outpatient settings. This study explored the perspectives and experiences of eight Norwegian nurse-midwives regarding the provision of the midwifery aspect of an antenatal consultation as part of the diabetes specialist team. METHODS: A qualitative descriptive study was used. Eight nurse-midwives aged between 37 and 58 years, representing four Norwegian hospital outpatient clinics, participated in individual interviews. Transcribed interviews were analysed in accordance with a qualitative thematic analysis. RESULTS: Three main themes were developed: "Approaching the women as persons in order to frame strengths and normalcy", "Managing different tasks judiciously" and "Balancing conflicting values". Some of the barriers were found to be related to the organisation of care, such as short timeframes with a medical focus, which overshadowed or forced the normalcy aspects of childbearing into the background. Managing risk and evidence-based knowledge were demanding tasks to fulfil in a judicious way. Some midwives experienced ambiguity while being forced to prioritise medical factors over woman-focused care while running others' errands, an act of balancing conflicting values. CONCLUSIONS: The contextual conditions related to the organisation present barriers for pregnant women to receive woman-focused care beyond the medical approach. The midwifery contribution in this care setting should be clearly recognised and defined so that women can capitalise on the different professionals and their expert competencies and contributions in this setting.

Implicações das restrições alimentares na vida diária de mulheres com diabete melito gestacional / Implications of diet restrictions in the daily lives of women with gestational Diabetes Mellitus / Implicaciones de las restricciones alimentares en la vida diaria de mujeres con Diabetes Mellitus en la gestación

A dieta é um dos principais focos do tratamento das gestantes diabéticas, constituindo-se em estratégia recomendada para um acompanhamento gestacional adequado e o nascimento de um bebê saudável. Trata-se de uma pesquisa qualitativa, do tipo descritivo, que objetivou conhecer as implicações das restrições alimentares na vida diária de mulheres com diabete melito gestacional. O estudo foi realizado em um hospital universitário do município de Porto Alegre/RS, por meio de entrevistas com 25 gestantes diabéticas em acompanhamento ambulatorial, entre os meses de julho a novembro de2010. A análise de dados foi do tipo temática. As mulheres apresentam dificuldades em seguir o plano alimentar prescrito, fato que provoca implicações negativas nas suas vidas diárias. A orientação nutricional deve ser flexível e respeitar a condição social de cada gestante. Há necessidade de elaboração de estratégias e propostas de cuidados que auxiliem essas mulheres no enfrentamento dos obstáculos relacionados à dieta alimentar.

Diet is one of the main focuses of treatment for diabetic pregnant women, and constitutes a recommended strategy for appropriate gestational monitoring and healthy childbirth. This qualitative, descriptive study examined the implications of diet restrictions in the daily lives of women with gestational diabetes mellitus. The study was performed between July and November 2010 at a university hospital in the city of Porto Alegre, Rio Grande do Sul, by means of interviews of 25 diabetic pregnant women in outpatient care. Data assessment was thematic. The women had difficulty sticking to the prescribed diet plan, which has adverse implications for their daily lives. Nutritional counseling should be flexible and contemplate the social condition of each pregnant woman. Care strategies and proposals should be developed to help these women surmount diet-related obstacles.

La dieta es un aspecto importante del tratamiento de las mujeres diabéticas embarazadas, que constituye una estrategia recomendada para un adecuado seguimiento del embarazo y el nacimiento de un hijo sano. Se trata de una pesquisa cualitativa, del tipo descriptivo que tuvo el objetivo de conocer las implicaciones de las restricciones alimentares en la vida diaria de las mujeres con Diabetes Mellitus en la gestación. El estudio fue realizado en un hospital universitario de la municipalidad de Porto Alegre/RS - Brasil, por medio de entrevistas con 25 gestantes diabéticas en acompañamiento ambulatorio,entre los meses de julio a noviembre de 2010. El análisis de datos fue del tipo temático. Las mujeres tienen dificultades para seguir el plan de la dieta prescrita, lo que provoca consecuencias negativas en sus vidas diarias. Asesoramiento nutricional debe ser flexible y respetar la condición social de cada mujer embarazada. Existe la necesidad de desarrollar estratégias y propuestas que ayuden esas mujeres a enfrentaren los obstáculos relacionados con la alimentación.

Intervenciones de enfermería en la atención de la paciente con diabetes mellitus gestacional en el primero, segundo y tercer nivel de atención / Nursing Interventions for care of patients with Gestational Diabetes Mellitus in first, second and third level of care

Introducción: La Diabetes Mellitus Gestacional se define como cualquier grado de hiperglucemia con primer reconocimiento durante el embarazo. En muchos de los casos los niveles de glucosa en sangre retornan a la normalidad después del parto. La mayoría de mujeres embarazadas son sedentarias o suspende el ejercicio, esto predispone al desarrollo de patologías como: hipertensión arterial, preeclampsia, disnea, obesidad materna e infantil y diabetes mellitus gestacional. Las mujeres con DMG no son capaces de compensar la resistencia a la insulina, producida por una combinación de cambios hormonales e inflamatorios. Método: Se realizó una búsqueda sistemática de información en PubMed, BVS, Tripdatabase, otras bases disponibles. Se analizaron 199 estudios de los últimos 5 años en idioma inglés y español, 23 fueron útiles para desarrollar esta guía. Resultados: La diabetes gestacional es la complicación metabólica más frecuente del embarazo con una prevalencia del 8% al 11% de todos los embarazos en México, ya que afecta a más de 10% de las embarazadas mayores de 25 años; los factores de riesgo para diabetes mellitus gestacional son: la raza, origen étnico, edad avanzada, antecedentes familiares de diabetes, aumento de índice de masa corporal. Conclusión: La implementación de las recomendaciones permitirá a los profesionales de enfermería favorecer la mejora en la prevención, atención y limitación del daño de la paciente con Diabetes Mellitus Gestacional. Mujer, embarazo, Diabetes Mellitus Gestacional, enfermería

Introduction: Gestational Diabetes Mellitus is defined as any degree of hyperglycemia with first recognition during pregnancy. In many cases the blood glucose levels return to normal after delivery. Most pregnant women are sedentary or suspend the exercise, this predisposes to the development of diseases such as hypertension, preeclampsia, dyspnea, child and maternal obesity and gestational diabetes mellitus. Women with GDM are not able to compensate for the insulin resistance produced by a combination of hormonal and inflammatory changes. Method: A systematic research for information in PubMed, BVS, Tripdatabase, other bases made available. 199 studies over the past 5 years in English and Spanish, 23 were analyzed and useful in developing this guide. Results: Gestational diabetes is the most common metabolic complication of pregnancy with a prevalence of 8% to 11% of all pregnancies in Mexico, affecting more than 10% of pregnant women older than 25 years; risk factors for gestational diabetes mellitus are: race, ethnicity, older age, family history of diabetes, increased body mass index. Conclusion: The implementation of the recommendations will enable nurses promote improved prevention, care and limiting damage to the patient with Gestational Diabetes Mellitus. woman, pregnancy, Gestational Diabetes Mellitus, nursing.

Introdução: Diabetes Mellitus Gestacional é definido como qualquer grau de hiperglicemia com primeiro reconhecimento durante a gravidez. Em muitos casos, os níveis de glicose no sangue voltar ao normal após parto.La maioria das mulheres grávidas são sedentários ou suspender o exercício, o que predispõe ao desenvolvimento de doenças como a hipertensão, pré-eclâmpsia, dispnéia, materna e obesidade infantil e diabetes mellitus gestacional. As mulheres com DMG não são capazes de compensar a resistência à insulina produzida por uma combinação de alterações hormonais e inflamatórias. Método: Uma busca sistemática de informações no PubMed, BVS, Tripdatabase, outras bases foi disponibilizado. 199 estudos ao longo dos últimos 5 anos no idioma Inglês e Espanhol, 23 foram analisadas foram úteis no desenvolvimento deste guia. Resultados: A diabetes gestacional é a complicação metabólica mais comum de gravidez com uma prevalência de 8% a 11% de todas as gravidezes no México, afetando mais de 10% das mulheres grávidas com idade superior a 25 anos; fatores de risco para diabetes mellitus gestacional são: raça, etnia, idade avançada, histórico familiar de diabetes, aumento do índice de massa corporal. Conclusão: A implementação das recomendações permitirá que os enfermeiros promovem a melhoria da prevenção, cuidados e danos limitando ao paciente com diabetes mellitus gestacional: Mulher, grávida, Diabetes Mellitus Gestacional, enfermagem.

Diabetes nurse educators' experiences of providing care for women, with gestational diabetes mellitus, from disadvantaged backgrounds.

AIMS AND OBJECTIVES: To explore diabetes nurse educators' experiences of providing care for women, with gestational diabetes mellitus, from disadvantaged backgrounds and to gather information which would assist with the development of an educational programme that would support both women and diabetes educators. BACKGROUND: Rates of gestational diabetes mellitus have increased dramatically in recent years. This is concerning as gestational diabetes mellitus is linked to poorer pregnancy outcomes including hypertension, stillbirth, and nursery admission. Poorest outcomes occur among disadvantaged women. gestational diabetes mellitus is also associated with maternal type 2 diabetes and with child obesity and type 2 diabetes among offspring. Effective self-management of gestational diabetes mellitus reduces these risks. Diabetes nurse educators provide most education and support for gestational diabetes mellitus self-management. DESIGN: An interpretative phenomenological analysis approach, as espoused by Smith and Osborn (Qualitative Psychology: A Practical Guide to Research Methods, 2008, Sage, London, 51), provided the framework for this study. METHODS: The views of six diabetes educators were explored through in-depth interviewing. Interviews were transcribed verbatim and analysed according to steps outlined by Smith and Osborn (Qualitative Psychology: A Practical Guide to Research Methods, 2008, Sage, London, 51). RESULTS: Three themes emerged from the data: (1) working in a suboptimal environment, (2) working to address the difficulties and (3) looking to the future. Throughout, the diabetes nurse educators sought opportunities to connect with women in their care and to make the educational content understandable and meaningful. CONCLUSIONS: Low literacy among disadvantaged women has a significant impact on their understanding of gestational diabetes mellitus information. In turn, catering for women with low literacy contributes to increased workloads for diabetes nurse educators, making them vulnerable to burnout. RELEVANCE TO CLINICAL PRACTICE: There is a need for targeted educational programmes for women with low literacy. Resources should be literacy appropriate, with photographs and simple text, and include culturally appropriate foods and information. This approach should lead to an improvement in the women's uptake of gestational diabetes mellitus information and may lead to a lessening of the workload burden for diabetes nurse educators.

Teoría y cuidados de enfermería: una articulación para la seguridad de la gestante diabética / Theory and nursing care- the articulation for the safety of the diabetic pregnant woman

La atención a la embarazada tiene como objetivo reducir al mínimo el riesgo de morbi mortalidad tanto para la madre como para el niño. La identificación temprana de los factores de riesgo permite una atención más especializada de acuerdo con el factor de riesgo que presente la paciente, y evitar complicaciones. Se realizó este trabajo con el objetivo de vincular la teoría de Ernestine Wiedenbach una de las grandes teóricas que hizo aportes a la enfermería con una de las afecciones que más afectan a las gestantes y las acciones independientes de enfermería, la diabetes mellitus. Se realizó una revisión bibliográfica del tema y de la vida y obra de esta teórica. Se concluyó que el adecuado control metabólico durante la gestación evita complicaciones maternas, fetales y neonatales. El cumplimiento de las acciones dependientes e independientes de enfermería en la gestante con diabetes ayuda a ésta en el control de su afección, y garantiza una seguridad para su salud. El modelo de Ernestine Wiedenbach cumple el objetivo para el que fue desarrollado al describir el ejercicio de la profesión, y contempla éste desde un punto de vista holistico(AU)

The care of pregnancy is aimed at reducing morbidity and mortality risk both for the mother and the child. The early detection of risk factors allows more specialized assistance according to the type of risk factor carried by the patient and prevention of complications. The objective of this paper was to link Ernestine Wiedenbach' s theory - one of the greatest contributions to nursing- with one of the diseases affecting more the pregnant women called diabetes mellitus. A literature review was made on the topic and on the existence and the work of this theory. It was concluded that the adequate metabolic control during pregnancy avoids maternal, fetal and neonatal complications. The fulfillment of independent and depending nursing actions aimed at the pregnant woman suffering from diabetes helps her to manage her illness and assures safe health condition. Ernestine Wiedenbach's model meets the objective for which it was created, since it describes the performance of the profession from a holistic viewpoint(AU)

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.