Diabetes in Pregnancy: A Review of Service Provision and Practice at a Maternity Center

TL;DR

This study reviews diabetes care during pregnancy at a maternity center in Qatar, finding gaps in documentation and screening practices.

Contribution

The paper provides a detailed audit of diabetes management in pregnancy aligned with national guidelines in Qatar.

Findings

36.1% of births were complicated by diabetes, with 34.6% being gestational diabetes.

Only 52.7% of women with diabetes had their pre-pregnancy weight documented.

Postpartum glucose testing was ordered for just 33.7% of women with gestational diabetes.

Abstract

Background: The worldwide incidence of hyperglycemia in pregnancy is rising with the increasing prevalence of diabetes globally. In Qatar, Gestational Diabetes (GDM) is highly prevalent, at 31.6% of all pregnancies. Diabetes in pregnancy is associated with adverse maternal and fetal complications. This quality improvement practice project aimed to review the care pathway for managing diabetes in pregnancy with reference to the National Diabetes Guideline. Method: A retrospective audit was conducted through a chart review of electronic medical records for women who delivered at a tertiary maternity unit in Qatar, between 1 July 2022 and 31 December 2022. The audited criteria and standards were based on the National Guideline for Diabetes in Pregnancy in Qatar. Results: There were 737 deliveries during the study period. Overall, diabetes complicated 36.1% of births, and GDM was diagnosed in 34.6%. Of the patients with GDM, 197 (77.3%) were on diet control, 49 (19.2%) were on Metformin, and 9 (3.5%) were on Insulin. Pré-pregnancy weight was documented only in 140 (52.7%) women with diabetes. Of all the women with GDM, 52.9% were referred to see a dietician. Only 9 out of 164(5%) women with a BMI greater than 30 kg/m2 had an early Oral Glucose tolerance (OGTT). Orders for postpartum OGTT were found for 33.7% of the women with GDM. Conclusions: The audit identified some gaps in the care pathway for managing diabetes during pregnancy, particularly in documentation practices, nutritional therapy referrals, and postpartum diabetes screening. Addressing these gaps and overcoming the implementation challenges are crucial for enhancing care quality.

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