Prenatal visit utilization and outcomes in pregnant women with type II and gestational diabetes

OBJECTIVE: To investigate the association between the number of prenatal visits (PNV) and pregnancy outcomes in women with gestational diabetes (GDM) and Type 2 diabetes (DM). STUDY DESIGN: A 4-year prospective cohort study of women with GDM and DM and was conducted. Patients ≥ 75(th) percentile for number of PNV were compared to those ≤ 25(th) percentile. The primary outcomes were large for gestational age (LGA) with birthweight > 90% and NICU admission for more than 24 hours. Secondary neonatal outcomes included severe LGA (>95%), shoulder dystocia, hyperbilirubinemia requiring phototherapy, neonatal hypoglycemia, low 5 minute APGAR score (<7) and preterm birth (prior to 37 weeks). Secondary maternal outcomes included mean 3(rd) trimester fasting blood glucose, hemoglobin A1c in labor, preeclampsia, gestational weight gain over Institute of Medicine recommendations, mode of delivery and maternal readmission within 30 days. Logistic regression was used to adjust for maternal race, nulliparity and BMI. RESULTS: Of 305 women, 4 were excluded for unknown number of PNV. Among the 301 included, the average number of visits was 12. Rates of LGA were similar between the high (28%) compared to low (18%) utilization groups (adjusted odds ratio [aOR] 1.69; 95% confidence interval [CI] 0.81–3.54). The high utilization group was 85% less likely to deliver an infant requiring NICU admission (aOR 0.15; 95% CI 0.04–0.53) and 59% less likely to have a preterm birth (aOR 0.41; 95% CI 0.21–0.80). A time-to-event analysis to account for the fact that patients who delivered earlier had fewer weeks to experience prenatal visits showed the risk for NICU admission was still significantly lower in the high prenatal visit utilization group (HR 0.15; 95% CI 0.04–0.51) after adjusting for confounders in a Cox proportional hazard model. The mean Hgb A1c at the time of delivery was significantly better in the high (6.4%) compared to low (6.9%) utilization groups (p=0.01). There were no differences in other maternal outcomes based on prenatal care utilization. CONCLUSION: Diabetic women with high PNV utilization have better glycemic control in the 3 months prior to delivery and are significantly less likely to deliver preterm infants or infants requiring NICU admission. There may be innovative ways to provide prenatal care for GDM and DM to optimize maternal and neonatal outcomes.