Impact of a diabetes midwifery educator on the diabetes in pregnancy service at Middlemore Hospital

We have assessed the effectiveness of a diabetes midwifery educator within a diabetes-in-pregnancy service serving a predominantly Polynesian population. A retrospective audit was undertaken of the charts of all women seen by the diabetes-in-pregnancy service at Middlemore Hospital, South Auckland for 8 months prior to introduction (n=76) and the same 8 months the following year (n=93). The women were well matched for age, ethnicity and past obstetric history. Previously known diabetes was present in 10%. After introduction of the role, insulin therapy (65% versus 50%. p<0.05), and maternal mean laboratory 2 hour post prandial glucose concentration (6.3±1.3 versus 5.7±1.0 mmol/l, p<0.01) were reduced and the proportion starting insulin as outpatients was increased (14% versus 89%, p<0.001). Birthweight and proportion receiving Caesarean delivery were non-significantly lower. Total antenatal length of stay (7.5±6.6 vs 3.0±3.3 per patient, p<0.001) was reduced. The proportion receiving a postnatal oral glucose tolerance test remained low but increased after the introduction of the follow up role (10% versus 29%, p<0.01). The introduction of the diabetes midwifery educator was associated with substantial reductions in resource utilisation with an improvement in glycaemic control and postnatal follow up.