Objective: To investigate the effectiveness of Nursing Case Management (NCM) on pregnant diabetics on maternal and fetal/neonatal outcomes

• Is there a difference in outcomes in pregnant diabetic women whom receive NCM services versus those who do not?
• Is there a difference in outcomes on pregnant diabetic women whom receive weekly/biweekly face to face visits with the NCM versus those who receive weekly/biweekly telephone NCM?

Design: A retrospective chart review of 93 pregnant women with preexisting diabetes (PED) and Gestational diabetics (GDM) and their offspring

Setting: A clinic setting and a private practice located within a large Midwestern hospital

Patients/Participants: Pregnant women with PED & GDM whose hemoglobin A1C (AIC) was greater than 6.5% between January 2003 and June 2009

Methods: Patients that received prenatal care between January 1, 2003 and June 2006 were the non NCM group.  Patients that received prenatal care in the private physician practice between July 2006 and June 2009 were the telephone NCM group.  Patients that received care in the clinic between July 2006 and June 2009 were the face to face NCM group.   A data collection sheet was created based upon maternal and neonatal outcomes related to diabetes in pregnancy.  The independent variables were participation in either type of NCM. The maternal dependent variables were A1C, preterm labor and preeclampsia.  The neonatal/fetal variables were macrosomia, respiratory distress syndrome, and plasma glucose level at birth. 

Results: A total of 93 pregnant women – 40 were in the non NCM group, 53 in NCM group (31 in the face to face NCM group and 22 in the telephone NCM group) were included in the analysis.  No significant differences between groups were observed except the A1C significantly decreased (p=.037) for both groups from 1^st trimester (non NCM A1C=9.27 (SD 2.6) & NCM A1C 8.96 (SD 1.7) to the 2^nd trimester (non NCM A1C=7.32 (SD 1.8), NCM A1C= 7.10 (SD 1.3) and the lower levels were sustained throughout the 3^rd trimester (non NCM A1C=7.16 (SD 2.1) & NCM A1C= 6.85 (SD 1.8). However, the NCM group maintained tighter glycemic control during the 2^nd & 3^rd trimester based upon the mean differences in A1C. 

Conclusion/Implications for nursing practice: Either method of NCM is effective in assisting pregnant diabetics improve their AIC, which is an indication of improved glycemic control which research shows contributes to improved birth outcomes.  Future research needs to be done to determine if strategies of glycemic control that was learned can be maintained long term.    

Keywords: Nursing, Case management, Diabetes, Pregnancy