Medical Nutrition Therapy in Gestational Diabetes Mellitus – Are outcomes different when delivered face-to-face versus by teleconference? — ASN Events
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  2. Session 3: Antenatal and Technology
  3. Medical Nutrition Therapy in Gestational Diabetes Mellitus – Are outcomes different when delivered face-to-face versus by teleconference?

Medical Nutrition Therapy in Gestational Diabetes Mellitus – Are outcomes different when delivered face-to-face versus by teleconference? (#17)

Stephanie Terry 1 , Tang Wong 1 2 3 , Robyn Barnes 1 , Laura Kourloufas 1 , Lisa Sengul 1 , Sabina John 1 , Natasha Diwakar 1 , Jeff Flack 1 2 3
  1. Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
  2. University of New South Wales, Sydney
  3. Western Sydney University, Sydney

Background: During the COVID-19 pandemic, Medical Nutrition Therapy (MNT) for Gestational Diabetes Mellitus (GDM) pregnancies changed from face-to-face (F2F) to teleconference (TC) to mitigate contagion risk at Bankstown-Lidcombe Hospital.

Aim: To compare pregnancy outcomes for GDM women who received MNT F2F versus TC in a multidisciplinary clinic.

Methods: Prospectively collected data were analysed for singleton GDM pregnancies (ADIPS 2014 criteria). Outcomes for women who received MNT F2F from August 2020-July 2021 were compared to those by TC from November 2021-October 2022. MNT included one initial group education followed by one individual review. All MNT F2F was completed in person whilst MNT by TC used Pexip InfinityConnectTM virtual platform for initial group education and then individual review by telephone. The same dietary information was provided in both modes of delivery.

Outcomes assessed were insulin therapy use, number of clinic reviews, maternal weight gain (total and in excess of Institute of Medicine recommendations), pre-term delivery (<37 weeks), caesarean section, small for gestational age (SGA<10th percentile), large for gestational age (LGA>90th percentile), neonatal hypoglycaemia (<2.6mmol/L) and jaundice (requiring phototherapy). Exclusions were ≥34 weeks’ gestation at diagnosis or ≤2 clinic appointments. Univariate analysis included independent sample t-tests and Chi-square tests for continuous and categorical data respectively.  Significant differences in baseline characteristics were adjusted for using a binary logistic regression model when looking specifically at LGA rates. P<0.05 indicated significance.

Results: Of 596 women, 323(54.2%) F2F and 273(45.8%) TC, women who received MNT F2F had higher mean fasting glucose (5.0±0.6vs4.8±0.6mM, p<0.05) and a higher proportion were of European ethnicity (24.8%vs15.0%, p<0.01) compared to those who received MNT by TC. There were no other significant differences in baseline characteristics.

Women who received MNT F2F had higher rates of insulin use (63.2vs52.0%, p<0.01), higher number of clinic reviews (8.5vs7.7episodes,p<0.05) and lower incidence of LGA (11.5vs17.2%, OR 0.62 95% CI 0.39-0.99, p<0.05). Following adjustment for European ethnicity, fasting glucose, number of clinic reviews and insulin use, LGA remained significantly lower in women receiving MNT F2F (adjusted OR 0.57 95% CI 0.35-0.93, p<0.05). There were no other significant differences in pregnancy and neonatal outcomes between the F2F and TC groups (see Table 1).

Conclusions: Delivery of MNT F2F resulted in a lower incidence of LGA even after adjustment for confounders. We postulate that face-to-face dietetic support may foster increased engagement with MNT, compared to TC support.

 

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