Background
Methods
Design and study population
Selective screening for GDM by the prognostic model
Implementation outcomes
Outcome | Definition | Indicator | OHP survey itema |
---|---|---|---|
Adoption | The initial decision to implement the prognostic model | The number of centres that started with the implementation of the prognostic model, divided by the total number of centres agreed to participate. | CP3 |
Acceptability | The perception among obstetric healthcare professionals that the prognostic model is agreeable, palatable, or satisfactory | NA | I1, I2, I4, U8, U17, C1, C3, C4, RM1–3 |
Appropriateness | The perceived fit, relevance, or compatibility of the prognostic model for a) midwifery practices, hospitals, obstetric healthcare professionals, pregnant women, or b) to improve selective screening for GDM | The number of pregnant women who appreciated information about their risk for GDM and how to decrease it, divided by the total number of women who responded to the questionnaireb | I7, U9, U10–12, GN1, C2, CP2, CA3 |
Feasibility | The extent to which the prognostic model can be successfully used or carried out within the midwifery practice or hospital | NA | I5, U13, U16, O19, O21, O23–27, GN2, CP1, CA1, CA2, CA4–7, RM5 |
Fidelity | The degree to which the prognostic model was implemented as it was described in the original protocol | Fidelity: the number of pregnant women who received the correct care pathway, divided by the total number of women in the study population.c Safety: the number of women with GDM that were selectively tested for GDM, divided by the total number of women with GDM.c Efficiency: the number of women without GDM that were not selectively tested for GDM, divided by the total number of women without GDM.c | NA |
Penetration | The integration of the prognostic model in the midwifery practices and hospitals | The number of pregnant women for whom the prognostic models was filled out, divided by all pregnant women.c The number of pregnant women who resported to have received information about their risk for GDM, divided by the total number of women who responded to the questionnaireb | U14, U15 |
Sustainability | The extent to which the use of the prognostic model is maintained within a midwifery practice or hospital | The number of centres that continued using the prognostic model after the study period, divided by the total number of centres that participated in the studyd | I6, O20, O28, GN3, CP4, RM4, E1–5. |
Data collection
Statistical analysis
Results
Study population
Determinant | Overall (n = 60) | Responder (n = 42) | Non-responder (n = 18) | P-value |
---|---|---|---|---|
Age (years) | 40 (31–51)a | 40 (32–52)b | 34 (30–43)c | 0.365 |
Sex (female) | 58 (96.7) | 41 (97.6) | 17 (94.4) | 0.530 |
Profession | ||||
Midwife, employed in independent midwifery practiced | 45 (75.0) | 32 (76.2) | 13 (72.2) | 0.145¶ |
Midwife, employed in hospitale | 3 (5.0) | 1 (2.4) | 2 (11.1) | |
Resident in obstetrics e | 3 (5.0) | 1 (2.4) | 2 (11.1) | |
Obstetriciansd | 9 (15.0) | 8 (19.0) | 1 (5.6) | |
Employed in obstetrics (years) | 12 (8–23)a | 12 (8–24)b | 10 (4–18)c | 0.350 |
Characteristics | Low risk (n = 721) | High risk (n = 352) | Overall (n = 1073) | ||
---|---|---|---|---|---|
no GDM (n = 711) | GDM (n = 10) | no GDM (n = 281) | GDM (n = 71) | ||
Age (years) | 31.0 (4.2) | 30.1 (3.0) | 32.3 (4.4) | 32.2 (4.7) | 31.4 (4.3) |
Body mass index (kg/m2) | 22.5 (20.6–24.3) | 23.6 (22.0–24.8) | 27.8 (25.0–31.2) | 30.1 (27.8–33.3) | 23.7 (21.4–27.3) |
Ethnicity (Caucasian) | 641 (90.2) | 9 (90.0) | 203 (72.5) | 51 (71.8) | 904 (84.2) |
Parity (nulliparous) | 318 (44.7) | 5 (50.0) | 93 (33.1) | 24 (33.8) | 440 (41.0) |
Spontaneous conception | 668 (94.0) | 10 (100) | 256 (91.1) | 69 (97.2) | 1003 (93.5) |
Pre-existent hypertension | 4 (0.6) | 0 (0.0) | 12 (4.3) | 2 (2.9) | 18 (1.7) |
Polycystic ovarian syndrome | 14 (2.0) | 0 (0.0) | 6 (2.1) | 5 (7.0) | 24 (2.2) |
History of gestational diabetes mellitus | 0 (0.0) | 0 (0.0) | 14 (5.0) | 17 (23.9) | 31 (2.9) |
History of macrosomiaa | 19 (2.7) | 1 (10.0) | 12 (4.3) | 7 (9.9) | 39 (3.6) |
History of unexplained intra-uterine fetal demise | 1 (0.1) | 0 (0.0) | 1 (0.4) | 2 (2.8) | 4 (0.4) |
Family history of diabetesb | 39 (5.5) | 1 (10.0) | 124 (44.1) | 27 (38.0) | 190 (17.7) |
First trimester glucose (mmol/L) | 4.6 (4.3–4.9) | 4.5 (4.1–4.8) | 5.0 (4.7–5.4) | 5.3 (4.9–5.6) | 4.7 (4.4–5.1) |
Hypertensive disorders of pregnancy | 73 (10.3) | 2 (20.0) | 43 (15.3) | 16 (22.5) | 134 (12.5) |
Induction of birth | 139 (19.5) | 5 (50.0) | 75 (26.7) | 37 (52.1) | 256 (23.9) |
Mode of birth (spontaneous) | 573 (80.6) | 3 (30.0) | 217 (77.2) | 47 (66.2) | 840 (84.4) |
Postpartum hemorrhage > 1000 ml | 60 (8.4) | 0 (0.0) | 19 (6.8) | 8 (11.3) | 87 (8.1) |
Maternal death | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Gestational age at birth (days) | 281 (274–286) | 276 (270–279) | 280 (272–287) | 273 (266–281) | 280 (273–286) |
Birthweight (grams) | 3500 (3140–3810) | 4008 (3712–4357) | 3507 (3155–3850) | 3480 (3088–3958) | 3500 (3140–3840) |
Small-for-gestational-agec | 83 (11.7) | 0 (0.0) | 35 (12.5) | 6 (8.5) | 124 (11.6) |
Large-for-gestational-agea | 55 (7.8) | 6 (60.0) | 39 (13.9) | 15 (21.1) | 118 (11.0) |
Apgar-score < 7 after 5 min | 11 (1.6) | 1 (10.0) | 6 (2.2) | 1 (1.4) | 19 (1.8) |
Shoulder dystocia | 18 (2.5) | 1 (10.0) | 10 (3.6) | 1 (1.4) | 30 (2.8) |
Birth trauma | 5 (0.7) | 0 (0.0) | 0 (0.0) | 1 (1.4) | 6 (0.6) |
Hypoglycemia < 2.6 mmol/L | 56 (7.9) | 3 (30.0) | 28 (10.0) | 20 (28.2) | 107 (10.0) |
Neonatal intensive care admission | 20 (2.8) | 0 (0.0) | 9 (3.2) | 2 (2.8) | 31 (2.9) |
Perinatal death > 22 weeks gestational age | 3 (0.4) | 0 (0.0) | 3 (1.1) | 0 (0.0) | 6 (0.6) |