04 Dec 2023
30 Nov 2023
Gestational diabetes mellitus and pre-existing diabetes have been recognized as a risk factor for a number of adverse outcomes during pregnancy, including macrosomia, birth trauma and cesarean delivery. Maintaining good glycemic control is the key intervention for reducing the frequency and severity of complications related to diabetes in pregnancy. One of the best approaches is multidisciplinary management in treating high risk pregnant women with gestational diabetes or pre-existing diabetes. This recognition has led to establish multidisciplinary team management including endocrinologist, obstetrician, dietician and diabetic educators in National Diabetes and endocrine centre in Royal hospital in April 2016. The aim of this study was to assess the efficacy of a comprehensive and multidisciplinary diabetes and pregnancy clinic in reducing risk of maternal and fetal outcome. This is a retrospective analysis of the maternal and fetal outcome of high risk pregnant women with gestational diabetes or pre-existing diabetes requiring insulin who has being followed in a tertiary hospital, Royal hospital before and after establishing the multidisciplinary management. The primary outcome was a composite of reduce number of admission, number of cesarean delivery, Pre eclampsia, and neonatal complications, including macrosomia, intrauterine fetal deaths and shoulder dystocia. Maternal and fetal outcome indicators were compared with same age groups and similar characters at two time periods, one before the implementation in January 2014 to March 2016 and the other was following the initiation of this comprehensive multidisciplinary program in (April 2016-March 2017). A 233 patients were enrolled from January 2014 to March 2016 before the implementation and 373 patients were enrolled after initiation the multidisciplinary program from April 2016 to March 2017. Follow up results revealed significant reductions in several prespecified outcomes, including cesarean delivery, number of admission, macrosomia and shoulder dystocia. Overall rate of fetal and maternal complications showed a significant improvement. Implementing a structured comprehensive multidisciplinary team approach in management of diabetes in pregnancy has a positive impact on improving the maternal and fetal outcome.