Improving maternal and neonatal outcomes for women with gestational diabetes through continuity of midwifery care: A cross-sectional study

Abstract

Problem: Gestational Diabetes Mellitus (GDM) is a complication of pregnancy which may exclude women from midwife-led models of care.

Background: There is a paucity of research evaluating the safety and feasibility of continuity of midwifery care (CoMC) for women with GDM.

Aim: To investigate the impact of CoMC on maternal and neonatal outcomes, for otherwise low-risk women with GDM.

Methods: This exploratory cross-sectional study observed maternal and neonatal outcomes including onset of labour, augmentation, labour analgesia, mode of birth, perineal trauma, gestation at birth, shoulder dystocia, infant birth weight, neonatal feeding at discharge.

Findings: Participants were 287 otherwise low-risk pregnant women, who developed GDM, and either received CoMC (n=36) or standard hospital maternity care (non-CoMC) (n=251). Women with GDM who received CoMC were significantly more likely to experience an spontaneous onset of labour (OR 6.3; 95% CI 2.7-14.5; p<.001), labour without an epidural (OR 4.2; 95% CI 2.0 - 9.2,<0.001) and exclusively breastfeed (OR 4.3; 95% CI 1.26 - 14.32; p=0.02).

Discussion: Receiving CoMC may be a public health initiative which not only improves maternal and neonatal outcomes, but also long-term morbidity associated with GDM.

Conclusion: Findings provide preliminary evidence suggesting CoMC improves maternal and neonatal outcomes and is likely a safe and viable option for otherwise low-risk women with GDM. Larger studies are recommended to confirm findings and explore the full impact of CoMC for women with GDM.

Keywords: Continuity of care; Gestational diabetes; Maternal and neonatal outcomes; Maternal health services; Midwifery; Model of care.