The Impact of a Self-Management-Based Cluster Pregnancy Care Model on Pregnant Women with Gestational Diabetes Mellitus (GDM)

Introduction

Anxiety and depression during pregnancy can lead to increased cortisol levels and insulin resistance, heightening the risk of gestational diabetes mellitus (GDM). Studies have shown that GDM can result in adverse pregnancy outcomes, including caesarean sections, premature delivery, and fetal macrosomia. These complications pose risks to both maternal and infant health, and GDM increases the likelihood of developing type 2 diabetes in the future.

Gestational diabetes affects the health of both the mother and baby and places an economic burden on healthcare systems. While standard clinical interventions are in place, they sometimes fail to significantly reduce these adverse outcomes. Researchers are exploring more effective nursing strategies, including the self-management-based cluster-based pregnancy care model (SMB-CPCM), to enhance maternal health outcomes.

The SMB-CPCM emphasizes group-based interaction, self-management skills, and peer support, improving maternal health and reducing pregnancy complications. This study investigates the SMB-CPCM’s efficacy in improving self-management abilities, psychological status, and pregnancy outcomes in women with GDM.

Methods

Design and Participants

Pregnant women with GDM who underwent routine prenatal care at the First Affiliated Hospital of Bengbu Medical College from April 1, 2023, to April 2, 2024, were enrolled. The study targeted a sample size of 120 through power analysis, adjusted for a 20% dropout rate. IBM SPSS version 24 was used to randomly assign participants to intervention and control groups of 60 each. Both groups received standard GDM care, along with additional interventions for the experimental group.

Treatment Protocol

The experimental group engaged in SMB-CPCM, incorporating group-based antenatal care and peer support. The control group underwent standard GDM care procedures as outlined in clinical guidelines. Key intervention components included regular health education, dietary advice, medication management, intensified blood glucose monitoring, exercise guidance, psychological care, and regular prenatal exams.

Variables and Measurements

To evaluate the intervention’s impact, outcomes included the GDM Self-Management Behaviour Scale, blood glucose levels, delivery outcomes, maternal anxiety, and depression levels. Baseline measurements were taken before the intervention and followed by measurements at six weeks post-intervention. Additionally, participants were followed up for five weeks post-discharge.

GDM Self-Management Behaviour Scale

This scale assesses adherence to self-management guidelines, including dietary control, physical activity, and medication use.

Pregnancy Anxiety Scale (PAS)

The PAS, consisting of 27 items, measures anxiety levels in pregnant women regarding delivery, self-perception, fetal health, and general anxiety. Scores range from 1 to 5, with higher scores indicating greater anxiety. The Cronbach’s alpha coefficient for the scale is 0.93.

Self-Rating Depression Scale (SDS)

The SDS, composed of 20 items, evaluates depressive symptoms, with higher standard scores indicating more severe depression. The Cronbach’s alpha coefficient for this scale is 0.91.

Blood Glucose Level

Fasting and postprandial blood glucose levels were measured at two stages before delivery to assess the effectiveness of interventions.

Delivery Outcome

Delivery outcomes included the method of delivery, incidence of gestational hypertension, polyhydramnios, premature membrane rupture, preterm birth, macrosomia, and postpartum hemorrhage.

Statistical Analysis

Data analysis was conducted using IBM SPSS version 26.0, with significance set at p < 0.05.

Results

Baseline Clinical Characteristics

A total of 120 participants were recruited, with 60 in each group. After intervention, one participant in the intervention group and two in the control group were excluded due to labor transfer, resulting in final sample sizes of 59 and 58, respectively. There were no significant differences in general information between the groups, ensuring comparability.

Table 2 Baseline Clinical Characteristics

Comparison of Self-Management Skills Scores

No significant difference was observed in baseline self-management skills. Post-intervention, significant improvements were noted in both groups, with the intervention group showing more pronounced enhancement.

Table 3 Comparison of Self-Management Skills Scores After Intervention

Comparison of Psychological Status

Before the intervention, there were no significant differences in maternal anxiety and depression levels. Post-intervention, both anxiety and depression scores reduced in the intervention group compared to baseline levels.

Table 4 Comparison of Psychological Status After Intervention

Comparison of Blood Glucose Levels

Neither group showed significant differences in blood glucose levels pre-intervention. Post-intervention, both groups exhibited decreased fasting and postprandial glucose levels, with more notable decreases in the intervention group.

Table 5 Comparison of Blood Glucose Levels After Intervention (mmol/L, X±s)

Comparison of Delivery Outcomes

The intervention group had a higher spontaneous delivery rate compared to the control group, with statistically significant differences. The incidence of gestational hypertension and macrosomia was lower in the intervention group.

Table 6 Comparison of Delivery Outcomes After Intervention [Cases (Percentage, %)]

Discussion

With China’s implementation of the “two-child policy,” the incidence of GDM has increased, presenting a significant public health challenge. Gestational diabetes is associated with various risks, including hypertension, preeclampsia, and the development of type 2 diabetes postpartum. These risks can affect not only the mother but also pose long-term health risks to the child. Poor glycemic control during pregnancy results in complications that can impact both maternal and neonatal health.

The SMB-CPCM aims to improve maternal self-management skills, facilitate emotional support, and promote social bonding among pregnant women. Enhancing self-management and reducing anxiety and depression can lead to better glycemic control, lower complication rates, and improved delivery outcomes.

The study results demonstrate that SMB-CPCM significantly improves self-management skills, reduces anxiety and depression, lowers blood glucose levels, and increases spontaneous delivery rates. These findings are consistent with other studies indicating the effectiveness of self-management in managing GDM.

Despite the benefits, the SMB-CPCM incurs higher direct costs initially, but the long-term reduction in complications and healthcare costs makes it a cost-effective strategy. The model’s potential for improving outcomes and managing gestational diabetes suggests its wider application and implementation.

Limitations and Strengths

This study was conducted at a single center, which may limit its generalizability. Future multicenter randomized controlled trials could provide more robust evidence. However, the intervention model shows promise in enhancing outcomes for pregnant women and newborns.

Conclusion

The SMB-CPCM, centered on pregnant women’s active engagements, empowers them to manage their condition effectively, reducing complications, improving pregnancy outcomes, and promoting psychological well-being. Despite its initial costs, its long-term benefits in reducing healthcare costs and improving health justify its implementation. This model holds significant potential in managing gestational diabetes and warrants further exploration.

Ethical Approval

This study complies with the Declaration of Helsinki.

Acknowledgments

We acknowledge Gayathri for her assistance with English language editing.

Funding

This study was funded by the Research Project of Universities in Anhui Province (No. 2022AH051414) and the Key Research Project of Humanities and Social Sciences of Bengbu Medical University (No. 2021byzd246sk).

Disclosure

The authors declare no conflicts of interest.

Your Thoughts Matter: Join the conversation by leaving a comment below, subscribing to our newsletter for updates, or sharing this article on your social media platforms. Thank you for reading!