The change in diagnostic criteria for gestational diabetes mellitus (GDM) has led to increased rates of diagnoses, prompting more women than ever before to consider, and ideally to improve, their diet and lifestyle. Concurrently, large international interventions have been conducted that aim to reduce risk of GDM in women who are at high risk, with mixed results. A critical aspect for an intervention’s success is to conduct it early in pregnancy, and, therefore, to identify high-risk women as soon as possible. As a high body mass index (BMI > 35), is a GDM risk factor, as stated in ADIPS consensus guidelines, it seems logical to identify and refer these women for dietetic assessment. One of the earliest opportunities for identification and referral is from the midwife’s initial antenatal assessment, usually conducted at 16 weeks gestation. Dietetic intervention can thus occur earlier in pregnancy than at GDM diagnosis, potentially improving obstetric and fetal outcomes.
An audit was conducted to investigate the number of women with GDM in a singleton pregnancy and a BMI ≥ 35 who attended a dietetic consultation prior to GDM diagnosis, in 2016.
Data were sourced from RWH electronic databases for 770 women with GDM in a singleton pregnancy during 2016. Of these, 12% (n=89) had a BMI ≥ 35 measured at the midwife assessment prior to GDM diagnosis. Of these 89 women, only 12% (n=11) women attended a dietetics consultation for assessment and support regarding their high BMI. This audit could not identify the number offered a referral but declined.
Improvements in diet and lifestyle can optimise obstetric and fetal outcomes, but early adoption of these patterns is ideal. Timely assessment and referral is imperative. The reasons for poor referral rates by midwives, or uptake by women, are unknown and warrant further investigation.