Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management Protocol
Background. Diabetes in pregnancy is associated with an increased risk to the woman and to the developing fetus. Currently, there is no consensus on the optimal management strategies for the follow-up and the timing of delivery of pregnancies affected by gestational and pregestational diabetes, with...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Journal of Diabetes Research |
| Online Access: | http://dx.doi.org/10.1155/2021/9959606 |
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| author | Maddalena Morlando Fabiana Savoia Anna Conte Antonio Schiattarella Marco La Verde Michela Petrizzo Mauro Carpentieri Carlo Capristo Katherine Esposito Nicola Colacurci |
| author_facet | Maddalena Morlando Fabiana Savoia Anna Conte Antonio Schiattarella Marco La Verde Michela Petrizzo Mauro Carpentieri Carlo Capristo Katherine Esposito Nicola Colacurci |
| author_sort | Maddalena Morlando |
| collection | DOAJ |
| description | Background. Diabetes in pregnancy is associated with an increased risk to the woman and to the developing fetus. Currently, there is no consensus on the optimal management strategies for the follow-up and the timing of delivery of pregnancies affected by gestational and pregestational diabetes, with different international guidelines suggesting different management options. Materials and Methods. We conducted a retrospective cohort study from January 2017 to January 2021, to compare maternal and neonatal outcomes of pregnancies complicated by gestational and pregestational diabetes, followed-up and delivered in a third level referral center before and after the introduction of a standardized multidisciplinary management protocol including diagnostic, screening, and management criteria. Results. Of the 131 women included, 55 were managed before the introduction of the multidisciplinary management protocol and included in group 1 (preprotocol), while 76 were managed according to the newly introduced multidisciplinary protocol and included in group 2 (after protocol). We observed an increase in the rates of vaginal delivery, rising from 32.7% to 64.5% (<0.001), and the rate of successful induction of labor improved from 28.6% to 86.2% (P<0.001). No differences were found in neonatal outcomes, and the only significant difference was demonstrated for the rates of fetal macrosomia (20% versus 5.3%, P: 0.012). Therefore, the improvements observed in the maternal outcomes did not impact negatively on fetal and neonatal outcomes. Conclusion. The introduction of a standardized multidisciplinary management protocol led to an improvement in the rates of vaginal delivery and in the rate of successful induction of labor in our center. A strong cooperation between obstetricians, diabetologists, and neonatologists is crucial to obtain a successful outcome in women with diabetes in pregnancy. |
| format | Article |
| id | doaj-art-bd69806dee164fe9ba7ac72a537bb781 |
| institution | Kabale University |
| issn | 2314-6753 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes Research |
| spelling | doaj-art-bd69806dee164fe9ba7ac72a537bb7812025-02-03T01:28:55ZengWileyJournal of Diabetes Research2314-67532021-01-01202110.1155/2021/9959606Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management ProtocolMaddalena Morlando0Fabiana Savoia1Anna Conte2Antonio Schiattarella3Marco La Verde4Michela Petrizzo5Mauro Carpentieri6Carlo Capristo7Katherine Esposito8Nicola Colacurci9Prenatal Diagnosis and High-Risk Pregnancy UnitPrenatal Diagnosis and High-Risk Pregnancy UnitPrenatal Diagnosis and High-Risk Pregnancy UnitPrenatal Diagnosis and High-Risk Pregnancy UnitPrenatal Diagnosis and High-Risk Pregnancy UnitUnit of DiabetesNeonatal Intensive Care UnitNeonatal Care UnitUnit of DiabetesPrenatal Diagnosis and High-Risk Pregnancy UnitBackground. Diabetes in pregnancy is associated with an increased risk to the woman and to the developing fetus. Currently, there is no consensus on the optimal management strategies for the follow-up and the timing of delivery of pregnancies affected by gestational and pregestational diabetes, with different international guidelines suggesting different management options. Materials and Methods. We conducted a retrospective cohort study from January 2017 to January 2021, to compare maternal and neonatal outcomes of pregnancies complicated by gestational and pregestational diabetes, followed-up and delivered in a third level referral center before and after the introduction of a standardized multidisciplinary management protocol including diagnostic, screening, and management criteria. Results. Of the 131 women included, 55 were managed before the introduction of the multidisciplinary management protocol and included in group 1 (preprotocol), while 76 were managed according to the newly introduced multidisciplinary protocol and included in group 2 (after protocol). We observed an increase in the rates of vaginal delivery, rising from 32.7% to 64.5% (<0.001), and the rate of successful induction of labor improved from 28.6% to 86.2% (P<0.001). No differences were found in neonatal outcomes, and the only significant difference was demonstrated for the rates of fetal macrosomia (20% versus 5.3%, P: 0.012). Therefore, the improvements observed in the maternal outcomes did not impact negatively on fetal and neonatal outcomes. Conclusion. The introduction of a standardized multidisciplinary management protocol led to an improvement in the rates of vaginal delivery and in the rate of successful induction of labor in our center. A strong cooperation between obstetricians, diabetologists, and neonatologists is crucial to obtain a successful outcome in women with diabetes in pregnancy.http://dx.doi.org/10.1155/2021/9959606 |
| spellingShingle | Maddalena Morlando Fabiana Savoia Anna Conte Antonio Schiattarella Marco La Verde Michela Petrizzo Mauro Carpentieri Carlo Capristo Katherine Esposito Nicola Colacurci Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management Protocol Journal of Diabetes Research |
| title | Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management Protocol |
| title_full | Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management Protocol |
| title_fullStr | Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management Protocol |
| title_full_unstemmed | Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management Protocol |
| title_short | Maternal and Fetal Outcomes in Women with Diabetes in Pregnancy Treated before and after the Introduction of a Standardized Multidisciplinary Management Protocol |
| title_sort | maternal and fetal outcomes in women with diabetes in pregnancy treated before and after the introduction of a standardized multidisciplinary management protocol |
| url | http://dx.doi.org/10.1155/2021/9959606 |
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