Nurse calls reduce risk from gestational diabetes

Education is key to good outcomes

Women with gestational diabetes who received telephone-based management from a nurse had a lower risk of high birth weight for newborns in a study conducted by the Kaiser Permanente Northern California Division of Research.

The women who received the telephone coaching also were more likely to have postpartum glucose testing, which leads to earlier identification and management of risks for diabetes, says Assiamira Ferrara, MD, PhD, a research scientist and lead investigator for the study.

"The patients with the best outcomes were followed by their physician but had additional telephone consultation from nurses who educated them and coached them to check their glucose levels and follow their diet," she adds.

The investigators in the study analyzed the association between referral to telephone-based nurse consultations and adverse infant outcomes. They used data from Kaiser Permanente Northern California's gestational diabetes registry to identify women who had pregnancies complicated by gestational diabetes.

During the study period, 96% of pregnant women without pre-existing diabetes were screened for gestational diabetes. Of the 11,435 women identified, 44.5% were referred to the Kaiser Permanente Regional Perinatal Service Center, where nurses provide supplemental care through telephone counseling to women with high-risk pregnancies, including those with gestational diabetes. The program's call center is staffed by 32 registered nurses and two registered dieticians and offers phone counseling seven days a week to address blood glucose monitoring and control, diet and physical activity.

Kaiser conducts the glucose tolerance test on pregnant women without pre-existing diabetes in the third trimester of pregnancy and refers women who have a positive result to their doctor for an additional visit as well as the nurse management program for telephone counseling. "Women are usually shocked when they get the diagnosis of gestational diabetes. The majority of the women are young, have normal weight, and have no idea they are at risk," Ferrara says.

The nurses at the center contact the women in the program two or three times a week, educating them about gestational diabetes and the importance of checking their glucose level every day after meals, Ferrara says. Participants in the program can call a toll-free number between 6 a.m. and 11 p.m. if they have questions or concerns.

Kaiser provides the women with a home glucose monitoring device. In addition, the center sends a laboratory slip for postpartum glucose testing and makes reminder calls to women who don't get the screening test.

"The first line of therapy is diet, and the nurses counsel the women on how to modify their diets to reduce their risk of elevated blood sugar," Ferrara says. If the glucose level doesn't reach normal levels after two weeks of following the diet suggested by the nurse, the nurse can initiate therapy with medication, she adds.

"Gestational diabetes can increase the risk of a premature delivery, babies with high birth weight, or low-weight babies. Keeping the blood glucose at normal levels results in healthier babies and lower healthcare costs," she says.