Diabetes and Nutrition Education for Pregnant Women With Preexisting Diabetes in Urban Alaska: A Retrospective Quality Improvement Study

Abstract

There has been a rise in the number of women entering pregnancy with preexisting type 1 and type 2 diabetes due to changing demographics of the obstetric population, including advanced maternal age and obesity. Uncontrolled diabetes during pregnancy is directly correlated with adverse perinatal outcomes. Educational approaches need to be taken to decrease the advancement of an intergenerational cycle of diabetes fueling the current global epidemic. This retrospective chart review aimed to evaluate the relationships between completion of education (i.e., diabetes or nutrition) and outcomes measures (i.e., glycemic control and birth outcomes) in mothers with preexisting diabetes at an urban Alaska health system for the purpose of quality improvement in clinical practice. Education provided by a registered dietitian nutritionist and/or certified diabetes educator in accordance with the American Diabetes Association Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes – 2020 improves clinical outcomes, behaviors, and quality of life. In this study, data from 78 charts were reviewed including BMI, HbA1c preconceptionally and during each trimester, pregnancy complications (i.e., preeclampsia), birth outcomes (i.e., gestational age, birth weight, cesarean delivery, shoulder dystocia, malpresentation, premature rupture of membrane, postpartum hemorrhaging, and fetal loss), demographics (i.e., age, employment status, ethnicity), and completion of diabetes education or nutrition education. The insufficient availability of outcome measures documented in medical charts and low numbers of medical record sharing among facilities limited the ability to evaluate the impact of education on glycemic control and subsequent birth outcomes in this study. The systematic evaluation of outcomes is the backbone to demonstrating the efficacy of registered dietitian nutritionists and certified diabetes educators in helping women achieve glycemic self-management outcomes. In terms of quality improvement, more documentation is needed. Medical data needs to reflect overall care provided in order to gauge the effect of iv education on glycemic control and birth outcomes. To decrease barriers of reviewing a chart, the extraction of chart data should be accomplished solely by the principal investigator. Recommendations for future outcomes studies should include collecting data on a continuum of clearly defined blood glucose levels during pregnancy to reflect the effect diabetes and nutrition education has on glycemic control and birth outcomes.