News 8 March 2021 | At Counties Manukau Health, pregnant women with gestational diabetes mellitus (GDM) diagnosed between 20 – 28-weeks’ gestation and with no other high-risk factors are now be cared through an alternative and new pathway led by an obstetrician with expertise in this condition. This obstetrician-led pathway will still be closely supported by endocrinologists and multidisciplinary team members. Women with high-risk pregnancies will continue to be managed via the existing multidisciplinary diabetes in pregnancy (DiP) pathway. Continuous risk assessment occurs during obstetrician-led follow-up and any significant increase in risk level will result in a seamless transfer of care to the standard DiP pathway. Referral to this pathway remains through the standard referral process for women with DiP who are then triaged to the obstetric- led pathway.
After a trial period, this new model/pathway of care was launched last year. Specific clinical criteria are applied to determine suitability for the new model, including body mass index (BMI) and blood sugar levels at diagnosis. Women suitable for the new obstetrician-led pathway are those who only require dietary modification, appropriate levels of exercise, with or without oral medication as management of GDM. Since September 2020, more than 110 women have been successfully cared for via this pathway. Streamlining care in this manner has resulted in an overall reduction in patient waiting times during clinic appointments, reduced clinic appointments for individual patients, and greater patient satisfaction, without compromising patient care in any way. Overall, patient antenatal care experience has improved as a result of the new model.
GDM accounts for 75 per cent of all women coming through the diabetes in pregnancy service. This is a form of diabetes which is expected to resolve following delivery, but which still carries a higher risk of developing type 2 diabetes (T2D) lifelong, compared to the general population. As such, post-partum screening and long-term re-screening is both recommended and important.