A randomized trial of nurse specialist home care for women with high-risk pregnancies: outcomes and costs. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. Care cost for pregnant and parturient women with diabetes and mild hyperglycemia. Diabetes in pregnancy: efficacy and cost of hospitalization as compared with ambulatory management--a prospective controlled study. MANAGEMENT OF THE PREGNANT DIABETIC: HOME OR HOSPITAL, WITH OR WITHOUT GLUCOSE METERS? Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil.
OBJECTIVE To examine prenatal , maternal , and infant outcomes and costs through 1 year after delivery using a model of prenatal care for women at high risk of delivering low-birth-weight infants in which half of the prenatal care was provided in women 's homes by nurse specialists with master 's degrees . STUDY DESIGN R and omized clinical trial . PATIENTS AND METHODS A sample of 173 women ( and 194 infants ) with high-risk pregnancies ( gestational or pregestational diabetes mellitus , chronic hypertension , preterm labor , or high risk of preterm labor ) were r and omly assigned to the intervention group ( 85 women and 94 infants ) or the control group ( 88 women and 100 infants ) . Control women received usual prenatal care . Intervention women received half of their prenatal care in their homes , with teaching , counseling , telephone outreach , daily telephone availability , and a postpartum home visit by nurse specialists with physician backup . RESULTS For the full sample , mean maternal age was 27 years ; 85.5 % of women were single mothers , 36.4 % had less than a high school education , 93.6 % were African American , and 93.6 % had public health insurance , with no differences between groups on these variables . The intervention group had lower fetal/infant mortality vs the control group ( 2 vs 9 ) , 11 fewer preterm infants , more twin pregnancies carried to term ( 77.7 % vs 33.3 % ) , fewer prenatal hospitalizations ( 41 vs 49 ) , fewer infant rehospitalizations ( 18 vs 24 ) , and a savings of more than 750 total hospital days and $ 2,496,145 [ corrected ] . CONCLUSION This model of care provides a reasoned solution to improving pregnancy and infant outcomes while reducing healthcare costs BACKGROUND We conducted a r and omized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications . METHODS We r and omly assigned women between 24 and 34 weeks ' gestation who had gestational diabetes to receive dietary advice , blood glucose monitoring , and insulin therapy as needed ( the intervention group ) or routine care . Primary outcomes included serious perinatal complications ( defined as death , shoulder dystocia , bone fracture , and nerve palsy ) , admission to the neonatal nursery , jaundice requiring phototherapy , induction of labor , cesarean birth , and maternal anxiety , depression , and health status . RESULTS The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group ( 1 percent vs. 4 percent ; relative risk adjusted for maternal age , race or ethnic group , and parity , 0.33 ; 95 percent confidence interval , 0.14 to 0.75 ; P=0.01 ) . However , more infants of women in the intervention group were admitted to the neonatal nursery ( 71 percent vs. 61 percent ; adjusted relative risk , 1.13 ; 95 percent confidence interval , 1.03 to 1.23 ; P=0.01 ) . Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group ( 39 percent vs. 29 percent ; adjusted relative risk , 1.36 ; 95 percent confidence interval , 1.15 to 1.62 ; P<0.001 ) , although the rates of cesarean delivery were similar ( 31 percent and 32 percent , respectively ; adjusted relative risk , 0.97 ; 95 percent confidence interval , 0.81 to 1.16 ; P=0.73 ) . At three months post partum , data on the women 's mood and quality of life , available for 573 women , revealed lower rates of depression and higher scores , consistent with improved health status , in the intervention group . CONCLUSIONS Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman 's health-related quality of life OBJECTIVE To compare inpatient and outpatient care costs for pregnant/parturient women with diabetes and mild hyperglycemia . METHODS A prospect i ve observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu , Southeastern Brazil , between 2007 and 2008 .  Direct and indirect costs and disease-specific costs ( medications and tests ) were estimated . Thirty diet-treated pregnant women with diabetes were followed up on an outpatient basis , and 20 who required insulin therapy were hospitalized . RESULTS The cost of diabetes disease ( prenatal and delivery care ) was US$ 3,311.84 for in patients and US$ 1,366.04 for out patients . CONCLUSIONS Direct and indirect costs as well as total prenatal care cost were higher for diabetic in patients while delivery care costs and delivery-postpartum hospitalization were similar . Prenatal and delivery-postpartum care costs were higher for these patients compared to those paid by Brazilian National Health System BACKGROUND Pregnant diabetic women are often subjected to frequent and prolonged hospitalizations to assure tight glycemic control , but in recent years attempts have been made at ambulatory control . The financial and social advantages of ambulatory management are obvious , but no report to date has prospect ively compared its efficacy with that of hospitalization . OBJECTIVES To evaluate the efficacy and cost of ambulatory care as compared to repeated hospitalizations for management of diabetes in pregnancy . METHODS We conducted an 8 year prospect i ve controlled study that included 681 diabetic women , experiencing 801 singleton pregnancies , with commencement of therapy prior to 34 gestational weeks . During 1986 - 1989 , 394 pregnancies ( 60 pregestational diabetes mellitus and 334 gestational diabetes mellitus ) were managed by hospitalization , and for the period 1990 - 1993 , 407 pregnancies ( 61 PGDM and 346 GDM ) were managed ambulatorily . Glycemic control , maternal complications , perinatal mortality , neonatal morbidity and hospital cost were analyzed . RESULTS There was no difference in metabolic control and pregnancy outcome in women with PGDM between the hospitalized and the ambulatory groups . Patients with GDM who were managed ambulatorily had significantly lower mean capillary glucose levels , later delivery and higher gestational age at induction of labor as compared to their hospitalized counterparts . In this group there were also lower rates of neonatal hyperbilirubinemia , phototherapy and intensive care unit admissions and stay . The saved hospital cost ( in Israeli prices ) in the ambulatory group was $ 6,000 and $ 15,000 per GDM and PGDM pregnancy , respectively . CONCLUSIONS  Ambulatory care is as effective as hospitalization among PGDM patients and more effective among GDM patients with regard to glycemic control and neonatal morbidity . This is not only more convenient for the pregnant diabetic patient , but significantly reduces treatment costs Thirteen pregnant insulin-dependent diabetic patients were allocated to blood-glucose self-monitoring ( meter ) or conventionally treated ( non-meter ) groups at 30 - -31 weeks . A day-profile of blood-glucose and intermediary metabolite levels was obtained 2 weeks later at home and after routine admission to hospital at 35 - -36 weeks . Metabolic profiles were also obtained in eight normal pregnant women of equivalent gestational ages admitted to hospital for study . The mean blood-glucose and metabolite concentrations in both the meter and non-meter groups were similar to those obtained in the non-diabetic pregnant women ( mean diurnal blood-glucose 4.6 + /- 1.1 mmol/l , meter group ; 5.3 + /- 1.5 non-meter group ; 4.8 + /- 0.8 controls ) . The diabetic control achieved at home was not improved by the use of a meter or admission to hospital ( mean glucose at home 5.0 + /- 1.3 and 6.3 + /- 1.6 mmol/l in hospital ) . Both the use of a meter and admission to hospital may be valuable in some patients . Neither , however , is essential for the good control of blood-glucose in all pregnant diabetics CONTEXT AND OBJECTIVE Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications . Hospital costs increase according to the type of care provided . This study aim ed to estimate the cost-benefit relationship and social profitability ratio of hospitalization , compared with outpatient care , for pregnant women with diabetes or mild hyperglycemia . STUDY DESIGN This was a prospect i ve observational quantitative study conducted at a university hospital . It included all pregnant women with pregestational or gestational diabetes , or mild hyperglycemia , who did not develop clinical intercurrences during pregnancy and who delivered at the Botucatu Medical School Hospital ( Hospital das Clínicas , Faculdade de Medicina de Botucatu , HC-FMB ) of Universidade Estadual de São Paulo ( Unesp ) . METHODS Thirty pregnant women treated with diet were followed as out patients , and twenty treated with diet plus insulin  were managed through frequent short hospitalizations .  Direct costs ( personnel , material s and tests ) and indirect costs ( general expenses ) were ascertained from data in the patients ' records and the hospital 's absorption costing system . The cost-benefit was then calculated . RESULTS Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care , respectively . The cost-benefit of inpatient care was US$ 143,719.16 , and outpatient care , US$ 253,267.22 , with social profitability of 1.87 and 5.35 , respectively . CONCLUSION Decision-tree analysis confirmed that successful treatment avoided costs at the hospital . Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization . The social profitability of both treatments was greater than one , thus demonstrating that both types of care for diabetic pregnant women had positive benefits
CONTEXT AND OBJECTIVE Pregnancies complicated by diabetes are associated with increased neonatal and maternal complications .
The most serious maternal complication is the risk of developing type 2 diabetes , 10 - 12 years after the delivery .
For rigorous control over blood glucose , pregnant women are treated through ambulatory management or hospitalization .
The aim of this study was to evaluate the effectiveness of ambulatory management versus hospitalization in pregnancies complicated by diabetes or hyperglycemia .