Management of gestational diabetes by family physicians and obstetricians.

BACKGROUND

Studies suggest that there are differences between family physicians' (FPs) and obstetricians' (OBs) management of women with low-risk pregnancies. This study was conducted to examine outcomes in women with gestational diabetes mellitus (GDM) to see if similar patterns exist between those cared for by FPs and those cared for by OBs.

METHODS

A retrospective chart review was undertaken and analyzed by prenatal care provider. Eight hundred thirteen women were identified as having a pregnancy complicated by GDM. Management outcome data of FPs and OBs were compared.

RESULTS

Eighteen percent of patients were cared for by FPs. The percentage with a prior history of GDM did not differ between groups. Patient groups were similar demographically except that FPs cared for a significantly higher percentage of patients on public assistance (60% vs 38%, P < .001). Average prepregnancy weight and body mass index were equal, as were average weight gain, gestational week at entrance to care, and number of prenatal visits. Class instruction on diabetes was given to 83% of FP patients and 85% of OB patients. A greater percentage of OB patients were placed on insulin therapy (33% vs 24%, P < .05). Complications of pregnancy, labor, and delivery were equal, but a higher number of OB patients had a cesarean section (33% vs 11% for FPs). Despite the equal occurrence of preterm labor/delivery and low birthweight, OBs used tocolysis in significantly more women than did FPs (10.3% vs 4.7%, P < .03). Average birthweight of infants delivered by FPs and OBs (3259 g and 3356 g, respectively), macrosomia rate (12% and 13%, respectively), length of pregnancy, fetal complication rate, Apgar scores, and length of hospital stays were all equivalent.

CONCLUSIONS

Although there are variations in the care of women whose pregnancy is complicated by gestational diabetes mellitus, there are no significant differences in neonatal outcome. There is, however, an overall lower rate of both cesarean section and tocolysis use among women cared for by FPs.