Table of Contents
The case-control study included 119 pregnant women who gave birth at a tertiary care center between August 2022 and January 2024.
Participants were divided into two groups. The case group consisted of 57 pregnant women who were diagnosed with gestational diabetes mellitus (GDM) and attended a diabetes school education program, and the control group consisted of 62 pregnant women who were diagnosed with GDM and attended a diabetes school education program. It was composed of Did not participate in diabetes school education program. (Figure 1) Patients diagnosed with diabetes between 24 and 26 weeks of gestation by a 75-g oral glucose tolerance test (OGTT) at a tertiary care teaching and research hospital were included in the study. Screening and diagnosis of GDM was performed using 75 g of OGTT between 24 and 26 weeks of gestation according to the International Diabetes of Pregnancy Study Group (IADPSG) guidelines. Gestational diabetes was diagnosed if at least one value of the 75g OGTT was positive: fasting plasma glucose level ≥ 92 mg/dl (5.1 mmol/L) and/or 1-hour glucose level ≥ 180 mg/dl (10.0 mmol/L) ) and/or 2-hour blood glucose level ≥ 153 mg/dl (8.5 mmol/L) [15].
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Pregnant women diagnosed with gestational diabetes with 75 g of OGTT between 24 and 26 weeks of pregnancy.
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Willing and able to provide informed consent to participate in the study.
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From 18 to 45 years old.
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Those who did not wish to participate in the study.
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People who have not been able to achieve glycemic control despite all appropriate treatment options.
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Who started and then stopped diabetes schooling?
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Those who did not continue prenatal care at our center.
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Those who gave birth at another facility.
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Women with multiple gestations, known type 1 or type 2 diabetes mellitus (DM), essential hypertension or hypertension during pregnancy, maternal malnutrition, liver or kidney disease, fetal structural or cytogenetic abnormalities.
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Known symptoms include glucose intolerance, polycystic ovary syndrome, maternal cardiovascular disease, and melanotic atoposis.
The staff who educate patients in diabetes schooling (e.g., perinatologists, endocrinologists, dietitians, diabetes nurses) are different from the staff who monitor pregnancies and make medical decisions about patients. Staff who make medical decisions about patients and monitor pregnancies do not know whether patients have attended diabetes training. Thus, it was ensured that pregnancy monitoring, medical decisions, and information processing in the outpatient clinic was no different from that for patients not participating in diabetes schooling.
Each patient in this group diagnosed with 75 g of OGTT between 24 and 26 weeks of gestation was followed up according to the Turkish Ministry of Health guidelines for high-risk pregnancies at the time of diagnosis. (Supplementary material 1) [16]. Patients were informed and given recommendations based on ACOG Practice Bulletin No. 190 (17). This information includes disease definitions, risk factors, treatment options, follow-up protocols, complications that may occur with or without treatment, labor management and timing of delivery, and complications that may occur in the baby after delivery. Possible complications, and postnatal follow-up protocols. The information ends with answers to the patient's questions. (The longest explanation lasted up to 20 minutes.) Patients underwent simultaneous testing and follow-up with an endocrinologist at the time of diagnosis. The maximum interval between endocrinologist examinations was one month. After diagnosis of gestational diabetes, the maximum interval between examinations by a perinatologist was 2 weeks. At each outpatient visit, both the perinatologist and endocrinologist checked the patient's health status and blood sugar levels. [for patients treated with insulin, 7 times daily (4 fasting, 3 postprandial); for patients not treated with insulin, blood glucose levels at least twice daily (1 fasting, 1 postprandial)]. At each outpatient visit, the need for insulin treatment and, if insulin was used, the adequacy of the current treatment dose was assessed by the perinatologist or endocrinologist, and necessary precautions were taken. In addition to the information provided by the endocrinologist and perinatologist, the diabetes nurse checked the patient's blood pressure and weight before the outpatient visit. Answered the patient's questions. When GDM was first diagnosed and abnormalities in blood glucose regulation were detected during prenatal care, a meeting with a dietitian was held in an outpatient setting. Education on insulin use (Supplementary Data 2) was repeated for GDM patients requiring insulin treatment.
This educational program was developed to supplement the education and information provided to all patients diagnosed with GDM. Diabetes training is conducted by three specialists: a diabetes nurse and a registered dietitian. Each patient participating in this training must be over 24 weeks pregnant and complete the training program within 2 weeks. Each session of the training program will consist of a total of 5 sessions and will last at least 45 minutes. Comprehensive training content (Supplementary Data 3) includes the definition of GDM, risk factors, diagnostic methods, maternal and fetal-neonatal complications that may occur in treated and untreated patients, and treatment. Includes strategies, dietary recommendations, exercise methods, and psychosocial topics.
Maternal age, gestational age, parity, BMI at delivery, total weight gain during pregnancy, HbA1c level at scheduled delivery, mode of delivery, and gestational age at delivery were recorded. Various factors including preterm birth (<37 weeks), birth weight (grams), neonatal hypoglycemia, need for phototherapy, 1- and 5-minute APGAR scores, neonatal respiratory distress syndrome (RDS), and intensive care unit admission. Neonatal outcomes were investigated. It was evaluated.
The difference between the two groups was that patients were provided with a standardized educational program as part of their diabetes education program, unlike the regular follow-up of pregnant women diagnosed with GDM. This program was more detailed in the information provided to patients and no topics were omitted. It was not left to the information initiative or content of the clinician. Although regular follow-up care was provided in the control group, these patients did not participate in a diabetes school education program, even though they were encouraged to do so.
For statistical analysis, data were analyzed using Jamovi, an open source statistical software. The normality of the variables was analyzed using both visual methods (histograms, probability plots) and statistical tests (Kolmogorov-Smirnov/Shapiro-Wilk test). Levene test was used to assess homogeneity of variance. For descriptive statistics, the means and standard deviations of variables were reported with normal distribution. Group comparisons for normally distributed variables were performed using independent samples t tests. For non-normally distributed numerical data, the median and interquartile range (Q1-Q3) were used for descriptive analysis, and the Mann-Whitney U test was used to compare groups. Categorical variables were described using frequencies and percentages, and if the chi-square assumption was violated due to a low expected value, the association between them was assessed by the chi-square test or Fisher's exact test. Ta. A p value less than 0.05 was considered statistically significant.