"Results suggest that a GDM diagnosis does not consistently lead to a 100% increase in prenatal care and that such care does translate into long-term benefits.”
—Maria Alva, Georgetown University
Effects of a Gestational Diabetes Mellitus (GDM) Diagnosis on Treatments and Long-Term Outcomes
Journal Article Jan-01-2023 , and 3-min read
Table of Contents
Table of Contents
Report Publish Date: January 2023
This article investigates the treatment patients receive and their long-term outcomes after they are diagnosed with gestational diabetes.
Primary Takeaways
The authors found that too many women are not getting the care they need for gestational diabetes, and those that do get care do not have improved outcomes.
- Fewer than half of women diagnosed with gestational diabetes received a prescription for care.
- Doctors were 30 percentage points more likely to prescribe medication, such as insulin, than nutrition therapy, even though clinical guidelines recommend starting with changes in eating habits.
- Very few women with gestational diabetes, less than 6%, have follow-up with a doctor about the condition after their pregnancy.
Overview and Objectives
About 7% of US births are affected by the mother’s gestational diabetes. The condition can cause complications for mother and child. Medical groups recommend that doctors screen for gestational diabetes between the 24th and 28th week of pregnancy.
The authors wanted to know what happens after pregnant people are screened: What treatments do they get, if any? And do they have complications, whether they are treated or not?
Hypothesis or Approach
The authors analyzed data on visits to doctors and lab results from the electronic health records of Geisinger, a large health system in Pennsylvania serving rural and medically underserved areas. They looked at interventions using medication, like insulin, and those that relied on nutrition.
How This Influences Change
Better practices are needed to treat gestational diabetes, monitor women after birth, and prevent the poor outcomes the condition can lead to for mothers and babies.
Research: Go Deeper
Importance: Gestational Diabetes Mellitus (GDM) is a prevailing medical concern during pregnancy. However, our current understanding of the probabilities and diverse treatment approaches administered to patients and long-term outcomes for patients with elevated glucose levels during pregnancy remains insufficiently documented.
Objective: Measure the effect of crossing the diagnostic threshold on receiving a GDM diagnosis, the type of treatment received (e.g., Medical nutrition therapy (MNT), insulin, metformin, glyburide), and long-term maternal health outcomes (systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and hemoglobin A1c levels).
Design: We use fuzzy regression discontinuity to estimate the impact of GDM diagnosis on the likelihood of receiving different treatments and longitudinal maternal outcomes.
Exposures: Primigravidae within 15 mg/DL above or below the cutoff point for GDM designation based on the second-worst score of the Carpenter & Coustan test.
Population: 13,868 primigravidae delivering in primarily rural and medically underserved areas, between January 1st, 2001, and December 31st, 2020, within a vertically integrated healthcare system, continuously enrolled during their pregnancy, with at least one patient encounter during pregnancy and in the year after delivery.
Results: 11% of women were lost to follow-up; 6.7% failed the Carpenter & Coustan diagnostic. There was only a 25.6% likelihood of getting a positive diagnosis around close calls (within 15 mg/DL of the cutoff). Less than 50% of women with a positive diagnosis received any prescription. Even though existing clinical guidelines recommend non-pharmacological interventions as the first line of action, a pharmacological response was 30pp more likely than a non-pharmacological one. Diagnosis within a small margin of the cutoff does not lead to clinically relevant improvements in SBP, DBP, BMI, or A1c, suggesting that the threshold defining GDM is conservative. While the guidelines call for universal A1c testing within three years of a positive GDM diagnosis, less than 6% of diagnosed women receive an A1c test.
Conclusions: We identified substantial gaps in the care cascade regarding adherence to guidelines and patient follow-up. A conservative clinical threshold can be beneficial in identifying potential cases early. This benefit should be weighed against the dangers of over-medicalization and lack of protocol compliance.
Maria Alva, Georgetown University, 2023
Research Team
This study and report was conducted and created by the following:
- Maria Alva
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