Researchers Compare Treatment Options to Minimize Risk of Gestational Diabetes

New study findings from JAMA Network show the potential benefit of group-based prenatal care (GPNC) along with individual prenatal care for gestational diabetes (GD). Researchers conducted the study to evaluate whether the different forms of care can reduce the risk of GD in pregnant individuals.

Pregnant woman checking blood sugar level | Image credit: Artursfoto - stock.adobe.com

GD is defined as a form of diabetes that is diagnosed for the first time during pregnancy. According to the study, 4% to 8% of individuals experience GD during pregnancy, as it is among the most common pregnancy complications.

“It is well-documented that the burden of GD differs by race and ethnicity. In the US, the prevalence of GD has been found to be highest among Asian individuals, followed by Hispanic, Black, and White individuals. Moreover, pregnancies affected by GD have increased risks of adverse outcomes, such as preeclampsia, primary cesarean delivery, birth injury, macrosomia, and large-for-gestational-age (LGA) birth. With its high prevalence and potential for adverse impact on both maternal and offspring health, prevention and management of GD is a major challenge for obstetrical care practitioners,” the study authors wrote.

The investigators noted that in previous studies of GD, race and ethnicity were rarely included and the goal was not to reduce the risk of GD. The studies instead focused on strategies to increase psychosocial health among individuals with GD.

GPNC is an advanced model seeking to provide medical care that can progress clinical outcomes and health behaviors, as well as reducing racial disparities. Compared with traditional individual prenatal care (IPNC), GPNC has showed a lower risk of progression for A2 GD, according to the authors of the current study.

The researchers explored this outcome by creating a secondary analysis of the CRADLE (Center and Racial Disparities) study. The single site, randomized clinical trial (RCT) focused on racially diverse pregnant individuals to define the results of GPNC for adverse effects and outcomes of GD. The study was conducted from February 2016 to March 2020 in South Carolina. The study enrolled 2350 participants who were between 14 and 45 years of age, 21 weeks or earlier in their pregnancy, and who had to partake in an 8-week follow up postpartum, if accessible. The data were analyzed from March 2021 to July 2022.

“Eligible participants were randomly assigned in a 1:1 allocation, stratified by race and ethnicity, to receive either GPNC (intervention) or IPNC (control) as their prenatal care. Due to the nature of the intervention, participants and practitioners were not blinded to group assignments. However, the study analysts were blinded to group assignments to reduce bias,” the study authors wrote.

Out of the 2350 participants, 1176 were placed in the GPNC group and 1174 were placed in the IPNC group. The primary outcome was a GD diagnosis between 24 and 30 weeks of gestation, with the secondary outcome of a progression of A2 GD. The results showed that the risks of GD within A2 GD and related adverse obstetric outcomes were comparable between GPNC and IPNC. The researchers did not observe a change in the development of GD in individuals of different races and ethnicities in GPNC, but the study allowed a greater analysis of benefits.

The findings suggest that although the risk of developing GD was similar in GPNC and traditional IPNC, GPNC could benefit for some patients as a treatment option, the investigators concluded.

Reference

Group vs Individual Prenatal Care and Gestational Diabetes Outcomes. Jama Network. News release. August 29, 2023. Accessed September 1, 2023. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808872.