The Impact of Neonatal Intensive Care Admission At Term Following Gestational Diabetes Mellitus: A Neglected Area.

Abstract

INTRODUCTION Gestational diabetes mellitus (GDM) is the most common complication of pregnancy, with rapidly rising prevalence due to increasing maternal age and a global obesity epidemic. GDM is associated with neonatal morbidities including admission to neonatal intensive care (NICU). The primary aim of the research is to explore the relationship between GDM and NICU admission for babies born at term. METHODOLOGY Phase 1 – A scoping review of the literature was undertaken to determine if current evidence suggests a link between GDM and an increased risk of admission to NICU for term babies. Phase 2 – A narrative review that compared and contrasted screening and diagnosis methods for GDM. Implications of using heterogenous research to build policy and guidance was also discussed. Phase 3 – A fully qualitative online survey explored women’s perception of admission to NICU. Responses were coded and analysed using thematic analysis. RESULTS The study findings are reported in three integrated papers. Paper 1 - Eight studies were identified. All found an association between GDM and increased risk of admission to NICU (three reached statistical significance). Only one study was UK based, and the diagnostic criteria used are no longer reflective of the current approach. Paper 2 – The review identified many approaches to screening and diagnosing GDM. The UK is one of very few places to adopt a risk-based approach to screening. Disparities in screening and diagnosis make comparison of research difficult and, as a result, the evidence used to support women’s education and decision-making is of poor quality. Paper 3 - Eighteen women participated in the survey. Two primary themes were identified: ‘experience’ and ‘understanding’, further separated into five and three sub-themes respectively. Clinical care is enhanced following GDM diagnosis, but participants identified a lack of understanding and knowledge. There is a need for improved education and joint decision making. CONCLUSION Current research suggests that there may be an association between a diagnosis of GDM and an increased risk of admission to NICU at term. However, this research is very limited with only one study from the UK. Disparities in screening and diagnosis mean women are likely to be categorised differently depending on their location at the point of testing, which could impact the accuracy of measured outcomes. Future research should include a UK based study to confirm whether GDM is associated with an increased risk of admission to NICU in this specific population. There is also a need for further education and better material to support women in their knowledge of NICU and to support decision making in pregnancy.