Monitoring Pregnant Women with GDM via the Internet

Temple University, Philadelphia PA

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Abstract

DESCRIPTION (provided by applicant): Gestational diabetes mellitus (GDM), which complicates between 3 and 5% of all pregnancies, is associated with an increase in perinatal morbidity. A significant relationship between maternal glycemic control and macrosomia as well as other adverse pregnancy outcomes has been clearly established. Therefore intensive management regimens, which aim to normalize blood glucose levels, are the mainstay of therapy in these pregnancies. Such an approach requires close medical surveillance with frequent communications between the health care provider and the woman with diabetes. However, current methods of surveillance, including frequent clinic visits and multiple telephone contacts, are labor intensive, costly, and not always uniformly applied particularly among inner city underserved populations. The purposed project enlists interactive technology between the health care provider and the patient at home to allow frequent monitoring of health status, to provide advice and education via a direct communication system. It is our hypothesis that the increased communication facilitated by this network will empower inner city women with GDM to take a more active role in their management, thereby improving maternal glucose control and leading to reductions in birth weight and ultimately other adverse outcomes. This preliminary study will attempt to determine if pregnant women with GDM can interact successfully with their health care providers via the diabetes health network. Eighty women with GDM will be randomized to one of two groups. Women in both groups will monitor their blood glucose levels four times a day, perform fetal movement counting three times day, and record insulin doses and episodes of hypoglycemia. Women in the experimental group will transmit their blood glucose levels and fetal movement counts to their health care providers via the diabetes health network three times a week. Women in the control group will record this information in a logbook, which will be reviewed by the medical team at prenatal visits. Key outcome variables will include infant birth weight, maternal blood glucose control and feelings of self-efficacy. Secondary outcome variables will include rate of macrosomia, neonatal morbidities, and admission to the Neonatal Intensive Care Unit. We expect this program to improve communications between patient and health care providers, enhance women's feelings of self-efficacy, improve glucose control and reduce birth weight.