A comparison of outcomes for gestational diabetics cared for in a university housestaff clinic versus a managed care system

OBJECTIVE: To compare intensity of prenatal care and subsequent maternal and neonatal outcomes in patients with gestationat diabetes mellitus (GDM) cared for in an inner city university hospital housestaff clinic (HS) versus an inner city managed care organization (HMO). STUDY DESIGN: A retrospective review of pregnancies complicated by GDM delivered at our institution between 1990 and 1996 was conducted. Inclusion criteria included diet controlled or insulin requiring GDM and prenatal care by the HS or HMO. Exclusion criteria were multiple gestations and known major fetal anomalies. Data were obtained on maternal demographics, and number of prenatal visits, sonograms, antenatal tests and antepartum admissions. Outcomes analy/ed included gestational age (GA) at delivery, birth weight, mode of delivery, maternal and neonatal lengths of stay (LOS), perinatal mortality, and admissions to the neonatal intensive care unit (NICU). Statistical analysis was performed using X and t-tests. RESULTS: The study groups consisted of 66 HS and 55 HMO patients. There were no differences in maternal demographics, nor in the number of prenatal visits or antepartum fetal heart rate tests between the two groups. HS patients had significantly more sonograms than HMO patients (x = 2.9 v 2.2, p = 0.02) and a greater rate of antepartum admissions (41% v 24%, p = 0.04). There was a lower incidence of third trimester fetal demise in the HS patients than in the HMO patients (0% v 5%, p < 0.0001). There were no significant differences between the groups in GA at delivery, mode of delivery, birth weight, maternal or infant LOS or NICU admissions. CONCLUSIONS: Inner city patients with GDM followed in a university HS clinic had a significantly lower incidence of fetal demise than those followed in a HMO. More intensive monitoring of fetal growth and glucose control by the HS clinic appeared to contribute to better perinatal outcomes in women with pregnancies complicated by GDM.