Abstract
Objective
The aim of the current study was to assess the effects of psychological intervention combined with 1‐day outpatient care on emotional well‐being, glycemic control, and pregnancy outcomes in women diagnosed with gestational diabetes (GD).
Methods
Pregnant women who underwent a 75‐g oral glucose tolerance test between 24 and 28 weeks of gestation from October 2022 to June 2024 and who were diagnosed with GD, received regular prenatal care, and who delivered at the study hospital were included. Women who voluntarily accepted the intervention were assigned to the intervention group, while those who did not were assigned to the control group. The intervention group received psychological intervention combined with 1‐day outpatient care along with standard diagnosis and treatment, whereas the control group attended routine outpatient clinics. Measures of emotional well‐being, glycemic control, and pregnancy outcomes were compared between the two groups.
Results
At study enrollment (24–28 weeks of gestation), no significant differences were observed between groups in Self‐Rating Anxiety Scale (SAS) or Self‐Rating Depression Scale (SDS) scores. However, SAS and SDS scores were significantly lower in the intervention group compared with the control group at 3 to 7 days postpartum. Similarly, no significant differences were noted in fasting plasma glucose (FPG), 2‐h postprandial glucose (2hPG), or glycated hemoglobin (HbA1c) at enrollment. Prenatal 2hPG and HbA1c levels were significantly lower in the intervention group compared with the control group, as were prenatal FPG levels and the number of cases with abnormal urine glucose and urine ketones. The rate of spontaneous vaginal delivery was higher in the intervention group. Incidences of hypertensive disorders of pregnancy, premature rupture of membranes, polyhydramnios, preterm birth, fetal macrosomia, and neonatal hypoglycemia were lower in the intervention group than in the control group.
Conclusions
Psychological intervention along with 1‐day outpatient care was associated with reductions in negative emotions such as anxiety and depression, improvements in glycemic self‐management, an increased rate of spontaneous delivery, reduced maternal and neonatal complications, and more favorable pregnancy outcomes in women with GD.
Keywords: 1‐day outpatient clinic, blood glucose management, gestational diabetes, negative emotion, pregnancy outcomes, psychological intervention
1. INTRODUCTION
Maternal and child health represents a fundamental component in the efforts to improve population quality. Following the liberalization of the “three‐child” policy in China, the number of advanced maternal age pregnancies has increased, contributing to a rising prevalence of gestational diabetes (GD), now recognized as one of the most common pregnancy‐related complications. 1 Globally, GD affects approximately 14.7% of pregnancies, while the prevalence in China is estimated at 14.8%, with an upward trend observed in recent years. 2 , 3 Pregnancy is associated with heightened emotional sensitivity, and a diagnosis of GD often exerts a psychological impact, leading to negative emotions such as anxiety and depression. These emotional responses are influenced by concerns related to blood glucose management, lifestyle modifications, maternal and child health, and pregnancy outcomes, ultimately increasing the risk of adverse obstetric outcomes. 4 According to research, effective psychological interventions can significantly contribute to the regulation of blood glucose levels in women with GD. 5 This study examined the effects of psychological intervention combined with 1‐day outpatient care on emotional well‐being, glycemic management, and pregnancy outcomes in women diagnosed with GD, as detailed below.
1.1. Participants and methods
1.1.1. Research participants
This prospective cohort study was conducted at the Wenzhou Central Hospital between October 2022 and June 2024. A total of 320 pregnant women diagnosed with GD between 24 and 28 weeks of gestation were enrolled and followed from diagnosis until the early postpartum period. Written informed consent was obtained from all participants before inclusion in the study.
Participant autonomy was fully respected during group allocation. Because participation in the 1‐day multidisciplinary outpatient intervention required an additional full day commitment (7:30 a.m. to 5 p.m.), group assignment was based on informed consent and voluntary participation rather than randomization. After routine prenatal screening identified women with GD, an independent researcher—who was not involved in participant recruitment or outcome assessment and had received specific training—provided a structured explanation of the 1‐day multidisciplinary intervention program. Women who agreed to participate were assigned to the intervention group (n = 160), whereas those who declined received standard GD outpatient management and formed the control group (n = 160).
Participants were eligible if they met the following criteria: (1) pregnant women aged ≥18 years and <35 years; (2) singleton pregnancy; (3) diagnosis of GD at 24 to 28 weeks of gestation based on a 75‐g oral glucose tolerance test according to established guidelines 6 ; (4) planned antenatal care and delivery at the study hospital; (5) no preexisting antenatal depression or other pregnancy‐related or systemic complications; and (6) ability to understand the intervention and provide informed consent.
Exclusion criteria were: (1) induced abortion or the occurrence of stressful events affecting maternal mood; (2) inability to complete regular prenatal checkups and delivery at the study center; and (3) voluntary withdrawal from the study.
Ethical approval for the study was obtained from the ethics committee of Wenzhou Central Hospital (approval number: Fast K2021‐04‐068), and written informed consent was provided from all women.
1.2. Research methods
1.2.1. Sample size calculation and grouping methods
Negative emotions, blood glucose management, and pregnancy outcomes at the time of enrollment and postpartum were selected as the primary indicators for evaluation. The sample size was calculated using the method of mean comparison between two samples, following the formula N1 = N2 = 2×[(tα/2 +tβ)S/δ]2, where the α value is 0.05 and table look‐up shows t0.052 = 1.96, the β value is 0.10 and table look‐up shows t0.1 = 1.28, the S represents the estimated standard deviation of the two populations, and δ is the difference between the two means. Accounting for an anticipated 20% loss to follow‐up rate, a total of 320 women were determined to be required for the study, based on the recommendations provided by Huang et al. 7
1.2.2. Research protocol
All enrolled participants were newly diagnosed with GD at the time of screening. Because the diagnosis was made promptly during routine screening, initial management for all women consisted of lifestyle modification, including dietary adjustment and exercise guidance. None of the participants required pharmacological treatment at enrollment. When lifestyle intervention alone failed to achieve glycemic targets, pharmacologic therapy—such as insulin—was initiated in accordance with clinical guidelines.
Participants in the control group received standard GD care based on national clinical guidelines, consisting of approximately 10 obstetric outpatient visits during pregnancy, inpatient management during delivery, and routine health education until childbirth.
Management included regular prenatal follow‐up, dietary and exercise counseling, perinatal health education, and routine psychological education; however, no structured psychological intervention was provided. In addition to standard care, participants in the intervention group attended a structured 1‐day multidisciplinary outpatient program between 24 and 28 weeks of gestation following the diagnosis of GD. The program combined psychological intervention with comprehensive outpatient nursing care. The multidisciplinary team consisted of obstetricians, psychologists, nutritionists, and maternal–child health nursing specialists. Continuous support and guidance were provided throughout the program. The intervention primarily consisted of face‐to‐face education and demonstration‐based training, covering specialist consultation, health education, blood glucose monitoring, psychological support, dietary management, exercise guidance, and appropriate use of glucose‐lowering medications. The detailed intervention workflow is presented in Table 1.
TABLE 1.
Flowchart of the intervention process combining psychological support and 1‐day outpatient care for pregnant women with GD.
| Time | Content | Time | Content |
|---|---|---|---|
| 7:30 | Record the vital signs such as body temperature, pulse rate, blood pressure, weight, and fasting blood glucose of pregnant women with GD, and inform them about the 1‐day outpatient clinic process and precautions | 12:30 | Arrange a lunch break for pregnant women with GD |
| 8:00 | Instruct pregnant women with GD to eat breakfast prepared by a dietitian | 13:20 | Instruct pregnant women with GD to move freely |
| 8:15 | Instruct pregnant women with GD to do appropriate light activities | 13:50 | Measure the blood glucose of pregnant women with GD at 2 h after meals |
| 8:30 | Instruct pregnant women with GD with the self‐glucose monitoring method | 14:00 | Instruct pregnant women with GD to eat additional meals prepared by a dietitian |
| 9:00 | Instruct pregnant women with GD on aerobic gymnastics | 14:15 | The dietitian explains and analyzes the blood glucose values of pregnant women with GD on that day, one‐on‐one, and gives suggestions according to the blood glucose and exercise amount of the day, and adjusts the individualized daily diet |
| 10:00 | Measure the blood glucose of pregnant women with GD at 2 h after meals | 14:45 | Psychologists give lectures on mental health during pregnancy and interact with pregnant women with GD. Fill in SAS and SDS forms, screen out high‐risk pregnant women, provide personalized psychological guidance, and do a good job of ensuring a follow‐up visit |
| 10:10 | Instruct pregnant women with GD to eat the additional meals developed by the dietitian | 16:00 | Summarize the learning knowledge of the day, and organize interactive question and answer session between doctors and patients |
| 10:30 | Obstetricians give health education lectures and explain the diagnosis and hazards of GD, predisposing factors, dietary control methods, food exchange, exercise, blood glucose monitoring and review, postpartum follow‐up, and preventive measures through videos and models | 16:30 | Follow‐up investigation: After the 1‐day outpatient clinic, record the psychological state and the mastery of related knowledge of pregnant women with GD, guide and record daily recipes and blood glucose conditions, and join the WeChat group of pregnant women with GD |
| 11:20 | Measure blood glucose before lunch in pregnant women with GD | Until delivery is complete | Monitor and get feedback of the emotional state of pregnant women with GD through the WeChat group Conduct blood glucose self‐test; medical staff should conduct online WeChat follow‐up at a fixed time every week, guide pregnant women with GD in the WeChat group to evaluate the results of self‐test blood glucose, provide health guidance on diet, exercise, psychology, medication, etc., make records, and remind pregnant women with GD to go for regular prenatal checkups |
| 11:50 | Instruct pregnant women with GD to eat lunch prepared by a dietitian and walk slowly after meals | Provide health guidance on diet, exercise, psychology and medication, keep records, and remind pregnant women with GD to have regular prenatal examination |
Note: Meals were prepared by dietitians with reference to the Guidelines for the Diagnosis and Treatment of Hyperglycemia in Pregnancy (2022), and the frequency and intensity of activities were designed by clinical nurse specialist in maternal‐child nursing with reference to the Guidelines for the Diagnosis and Treatment of Hyperglycemia in Pregnancy (2022).
Abbreviations: GD, gestational diabetes; SAS, Self‐Rating Anxiety Scale; SDS, Self‐Rating Depression Scale.
1.2.3. Observation indicators
Baseline demographic and clinical information was collected for both groups, including age, gravidity, parity, gestational age, body massindex, gestational weight gain, fasting plasma glucose (FPG), 2‐h postprandial blood glucose (2hPG), glycated hemoglobin A1c (HbA1c), Self‐Rating Anxiety Scale (SAS), Self‐Rating Depression Scale (SDS) score, education level, and family history of diabetes.
Negative emotional status was assessed using the SAS and SDS. 8 Scores were recorded at two time points: at baseline (24–28 weeks of gestation, before intervention) and during the early postpartum period (3–7 days after delivery). Emotional status was assessed 3 to 7 days postpartum because this period corresponds to the early postpartum recovery stage, during which maternal psychological adjustment becomes evident. Assessing emotional status during this window allows early identification of emotional changes while minimizing recall bias.
All pregnant women with GD who filled out the form provided informed consent and answered and submitted the questionnaire on the spot, with a designated person responsible for collecting the questionnaires on site. The SAS comprises 20 items, each scored from 1 to 4 points, yielding a total score range of 20 to 80 points. A standard cutoff score of 50 points was used, with scores ≥50 indicating the presence of anxiety; higher scores reflect greater severity of anxiety. Similarly, the SDS includes 20 items, each scored from 1 to 4 points, with a total score range of 20 to 80 points. A standard cutoff score of 53 points was applied, with scores ≥53 indicating the presence of depression; higher scores correspond to greater severity of depressive symptoms. 9 , 10
Blood glucose management (FPG, 2hPG, HbA1c), urine glucose, and urine ketone levels were recorded and compared between the two groups. To avoid distortion of data caused by physiological changes occurring during labor, the FPG, 2hPG, and HbA1c levels obtained at the most recent prenatal examination after 37 weeks of gestation were recorded as each participant's final prenatal glycemic data.
Maternal and neonatal outcomes, including the number of normal spontaneous delivery, forceps, cesarean section, hypertensive disorders of pregnancy (HDPs), premature rupture of membranes (PROMS), polyhydramnios, preterm birth, fetal macrosomia, and neonatal hypoglycemia, were recorded and compared between the two groups.
1.3. Data analysis methods
Statistical analyses were performed using SPSS version 26.0 (IBM). The normality of continuous variables was assessed using the Shapiro–Wilk test. Continuous variables with a normal distribution are presented as mean ± standard deviation (x ± s) and were compared between groups using the independent‐samples t test. Continuous variables that were not normally distributed are presented as median (interquartile range) and were compared using the Mann–Whitney U test, with results reported as Z values. Categorical variables are expressed as number (percentage) and were compared using the χ 2 test or Fisher exact test when appropriate. All statistical tests were two‐tailed, and a P value <0.05 was considered statistically significant.
2. RESULTS
2.1. Comparison of the general conditions between the two groups
Among the 160 pregnant women initially enrolled in the intervention group, nine women were lost to follow‐up. The reasons for loss to follow‐up included nonmedical factors leading to preterm birth (n = 2), loss of contact or voluntary withdrawal (n = 4), and transfer to other hospitals for delivery (n = 3). Similarly, among the 160 pregnant women in the control group, 11 women were lost to follow‐up, comprising cases of loss of contact or voluntary withdrawal (n = 7) and transfer to other hospitals for delivery (n = 4). Ultimately, 300 women completed the study, including 151 in the intervention group and 149 in the control group. There was no statistical difference between the two groups in age, gravida, parity, gestational weeks, body mass index, gestational weight gain, SAS, SDS score, FPG, 2hPG, HbA1c, education level, family history of diabetes, and other aspects (P > 0.05) (Table 2).
TABLE 2.
Baseline characteristics of participants in the two groups.
| Variable | Intervention group (n = 151) | Control group (n = 149) | t/χ 2 Value | P value |
|---|---|---|---|---|
| Age (years) | 29.50 ± 3.02 | 29.17 ± 3.25 | 0.904 | 0.366 |
| Gravidity >1 | 75 (49.67) | 84 (56.38) | 1.163 | 0.245 |
| Parity >1 | 43 (28.48) | 54 (36.24) | 1.437 | 0.151 |
| Gestational age at enrollment (weeks) | 26.76 ± 0.96 | 26.63 ± 0.97 | 1.149 | 0.250 |
| BMI at enrollment (kg/m2) | 25.10 ± 3.60 | 25.67 ± 3.73 | −1.351 | 0.177 |
| Gestational weight gain at enrollment (kg) | 6.46 ± 3.80 | 6.69 ± 3.32 | −0.558 | 0.577 |
| SAS score | 46.34 ± 8.95 | 46.11 ± 7.78 | 0.247 | 0.805 |
| SDS score | 43.74 ± 9.63 | 43.64 ± 10.01 | 0.085 | 0.932 |
| FPG (mmol/L) | 6.22 ± 0.96 | 6.27 ± 1.13 | −0.412 | 0.680 |
| 2hPG (mmol/L) | 9.53 ± 1.63 | 9.68 ± 1.46 | −0.868 | 0.386 |
| HbA1c (%) | 6.63 ± 1.02 | 6.45 ± 0.96 | 1.614 | 0.107 |
| Education ≥junior college | 105 (69.54) | 101 (67.79) | 0.326 | 0.745 |
| Family history of diabetes | 22 (14.57) | 23 (15.44) | 0.209 | 0.834 |
Note: Values are presented as mean ± standard deviation or number (percentage).
Abbreviations: 2hPG, 2‐h postprandial glucose; BMI, body mass index; FPG, fasting plasma glucose; HbA1c, glycated hemoglobin; SAS, Self‐Rating Anxiety Scale; SDS, Self‐Rating Depression Scale.
2.2. Comparison of negative emotions between the two groups
There was no significant difference in SAS and SDS scores and the number of patients exceeding the threshold between the two groups at the time of enrollment (P > 0.05). However, at 3 to 7 days postpartum, the SAS and SDS scores and the number of patients exceeding the threshold in the intervention group were significantly lower than those in the control group (all P < 0.05) (Table 3).
TABLE 3.
Comparison of anxiety and depression scores between the two groups.
| Variable | Intervention group (n = 151) | Control group (n = 149) | Statistic | P value |
|---|---|---|---|---|
| SAS score 24–28 weeks | 46.25 (41.38,53.50) | 47.00 (40.00,51.25) | Z = 0.247 | 0.805 |
| SAS score 3–7 days postpartum | 35.00 (31.00,42.00) | 38.00 (33.00,45.00) | Z = −4.395 | <0.001 |
| SDS score 24–28 weeks | 43.75 (37.50,50.50) | 43.25 (35.00,51.00) | Z = 0.085 | 0.932 |
| SDS score 3–7 days postpartum | 32.00 (28.00,38.65) | 37.75 (32.00,46.00) | Z = −4.908 | <0.001 |
| SAS ≥50 at 24–28 weeks | 53 (35.10) | 54 (36.24) | χ 2 = 0.042 | 0.837 |
| SAS ≥50 postpartum | 6 (3.97) | 20 (13.42) | χ 2 = 6.29 | 0.012 |
| SDS ≥53 at 24–28 weeks | 25 (16.57) | 31 (20.81) | χ 2 = 1.18 | 0.278 |
| SDS ≥53 postpartum | 3 (1.99) | 18 (12.08) | χ 2 = 10.00 | 0.002 |
Abbreviations: SAS, Self‐Rating Anxiety Scale; SDS, Self‐Rating Depression Scale. Continuous variables are presented as median (interquartile range).
2.3. Changes in blood glucose levels between the two groups
At enrollment, no significant differences were observed between the two groups in FPG, 2hPG, HbA1c levels (P > 0.05). Following the combined intervention, during the period from 37 weeks of gestation to delivery, the most recent measurements of FPG, 2hPG, and HbA1c in women with GD were lower in the intervention group compared with the control group. The difference in FPG was not statistically significant (P > 0.05), whereas the differences in 2hPG and HbA1c were statistically significant (P < 0.05). The number and proportion of individuals with abnormal urine glucose and urine ketone bodies in the research group were lower than those in the control group, yet the difference was not statistically significant (P > 0.05) (Table 4).
TABLE 4.
Comparison of glycemic indicators between the two groups.
| Variable | Intervention group (n = 151) | Control group (n = 149) | t Value | P value |
|---|---|---|---|---|
| FPG at enrollment (mmol/L) | 6.22 ± 0.96 | 6.27 ± 1.13 | −0.412 | 0.680 |
| 2hPG at enrollment (mmol/L) | 9.53 ± 1.63 | 9.68 ± 1.46 | −0.868 | 0.386 |
| HbA1c at enrollment (%) | 6.63 ± 1.02 | 6.45 ± 0.96 | 1.614 | 0.107 |
| FPG before delivery (mmol/L) | 4.86 ± 0.76 | 5.07 ± 1.12 | −1.838 | 0.066 |
| 2‐h PG before delivery (mmol/L) | 6.89 ± 1.55 | 7.40 ± 1.40 | −2.964 | 0.003 |
| HbA1c before delivery (%) | 5.72 ± 0.46 | 5.94 ± 0.50 | −3.999 | <0.001 |
| Urine glucose abnormal | 4 (2.65) | 5 (3.36) | χ 2 = 0.13 | 0.721 |
| Urine ketones abnormal | 4 (2.65) | 8 (5.37) | χ 2 = 1.43 | 0.231 |
Note: Values are presented as mean ± standard deviation or number (percentage).
Abbreviations: 2hPG, 2‐h postprandial glucose; BMI, body mass index; FPG, fasting plasma glucose; HbA1c, glycated hemoglobin.
2.4. Comparison of pregnancy outcomes between the two groups
The number and proportion of spontaneous vaginal deliveries (excluding instrumental deliveries) were higher in the intervention group than in the control group, while the number and proportion of cesarean sections were lower; these differences were statistically significant (P < 0.05). The number and proportion of forceps deliveries were lower in the intervention group compared with the control group, but the difference was not statistically significant (P > 0.05). The incidences of adverse maternal outcomes, including HDP, PROMS, polyhydramnios, and preterm birth, were lower in the intervention group than in the control group. Similarly, the incidences of adverse neonatal outcomes, including fetal macrosomia and neonatal hypoglycemia, were lower in the intervention group. These differences were statistically significant (all P < 0.05) (Table 5).
TABLE 5.
Comparison of pregnancy outcomes between the two groups.
| Outcome | Intervention group (n = 151) | Control group (n = 149) | χ 2 value | P value |
|---|---|---|---|---|
| Spontaneous vaginal delivery | 91 (60.26) | 72 (48.32) | 4.34 | 0.037 |
| Instrumental delivery | 2 (1.32) | 4 (2.68) | 0.70 | 0.402 |
| Cesarean section | 58 (38.41) | 73 (48.99) | 3.87 | 0.049 |
| HDPs | 4 (2.65) | 14 (9.40) | 6.09 | 0.014 |
| PROMS | 25 (16.56) | 41 (27.52) | 5.30 | 0.021 |
| Polyhydramnios | 4 (2.65) | 12 (8.05) | 4.33 | 0.037 |
| Preterm birth | 5 (3.31) | 14 (9.40) | 4.72 | 0.030 |
| Fetal macrosomia | 4 (2.65) | 14 (9.40) | 6.09 | 0.014 |
| Neonatal hypoglycemia | 7 (4.64) | 20 (13.42) | 7.14 | 0.007 |
Note: Values are presented as number (percentage).
Abbreviations: HDP, hypertensive disorder of pregnancy; PROMS, premature rupture of membranes.
3. DISCUSSION
The findings of this study suggest that psychological intervention combined with a structured 1‐day multidisciplinary outpatient program can effectively integrate multidisciplinary healthcare resources to provide comprehensive management for women with GD. This approach improves symptoms of anxiety and depression, enhances self‐management of blood glucose, reduces the risk of adverse pregnancy outcomes, and increases the rate of vaginal delivery. Therefore, the model demonstrates potential clinical value in the management of GD.
The global incidence of GD continues to rise. 11 The change in contemporary women's views on marriage and childbearing has led to an increase in advanced maternal age and multiple pregnancies, posing more severe prevention and control pressure on GD. 12 Due to the pressure of disease management, the incidence of anxiety and depression among pregnant women with GD is significantly higher than that among healthy pregnant women 13 , 14 , 15 ; negative emotions can further deteriorate adverse pregnancy outcomes. 16
At present, the research on GD intervention at home and abroad mainly focuses on diet, exercise, monitoring, and drugs, but does not pay enough attention to mental health, and there are few studies on psychological intervention. Exploring simple and effective methods to alleviate the negative emotions of pregnant women with GD, improve blood glucose, and reduce adverse pregnancy outcomes has become an important clinical matter.
The results of this study show that psychological intervention effectively reduces the SAS/SDS scores of GD puerpera and has a positive effect on improving the postpartum psychological state of GD puerpera, which was consistent with the findings of Shang et al. 17 Psychological intervention can improve the mental health awareness of pregnant women with GD and equip them with strategies, provided by doctors and nurses, for coping with negative emotions. One‐day outpatient visits can promote peer support and alleviate negative emotions of pregnant women with GD. WeChat provides continuous medical support to realize early detection and early intervention of anxiety and depression in pregnant women with GD.
The relief of anxiety and depression is related to the improvement of hormone balance, diet compliance, inflammatory factors, mood, sleep and blood glucose control, which together reduce the occurrence of adverse pregnancy outcomes. 13
Studies have shown that pregnant women with GD need to actively manage their blood sugar to improve pregnancy outcomes. 18 , 19 Pregnant women with GD often have insufficient self‐management ability. 20 Therefore, it is crucial to implement psychological intervention combined with multidisciplinary outpatient nursing in light of their physiological characteristics, lack of knowledge, poor compliance, and psychological vulnerability. 21 The 1‐day outpatient mode covers the core content of diet, psychology, monitoring, and exercise through concentrated education, practical demonstration, and personal participation, so that pregnant women with GD can obtain a comprehensive and effective experience in a day, improve their cognition and skills of blood glucose monitoring, and strengthen their self‐management ability through follow‐up. 22 , 23
This study revealed that after the combined 1‐day outpatient intervention, the average values of prenatal FPG, 2hPG, and HbA1c, as well as the number of cases with abnormal urine glucose and urine ketone bodies in the study group, were all lower than those in the control group. This indicates that this model may enable pregnant women with GD to self‐manage blood glucose more effectively, which is consistent with the conclusion of Wang et al. 23 WeChat group management enhances the compliance of blood glucose self‐measurement among pregnant women with GD, enabling medical staff to promptly implement remote intervention and effectively control their blood glucose levels. The mean FPG in the intervention group was 0.203 mmol/L lower than that in the control group, which may be due to the initiative of pregnant women with GD to improve dinner intake and reduce nocturnal glucose release after the 1‐day outpatient intervention, or it may be related to individual differences. Urine glucose and ketone bodies are important auxiliary indicators of GD management. The number and proportion of individuals with abnormal urine sugar and ketone bodies in the intervention group were both lower than those in the control group. Although none of the aforementioned differences reached statistical significance, the downward trends of FPG, urinary glucose, and urinary ketone bodies in the intervention group may indicate that the combined intervention strategy contributes to more stable blood glucose control.
The number and proportion of spontaneous vaginal deliveries in the observation group were higher than those in the control group, while the number and proportion of cesarean sections and forceps deliveries were lower than those in the control group, indicating that the 1‐day outpatient care promoted natural delivery by improving the participation, confidence, and skills of pregnant women in childbirth, and effectively reduced the risk of mechanical damage to maternal soft tissues during forceps delivery.
GD increases the risk of HDP and polyhydramnios in pregnant women, which, in turn, leads to premature birth and PROMS. One‐day care significantly reduced the incidence of HDP, polyhydramnios, PROMS, and preterm birth in the intervention group by promoting blood glucose control and improved pregnancy outcomes, which was consistent with the findings by Che et al. 24 High blood sugar in pregnant women with GD stimulates insulin secretion in the fetus through the placenta, increasing the risk of macrosomia and causing hypoglycemia in newborns. The 1‐day outpatient service significantly reduced the incidence of hypoglycemia in macrosomic infants and newborns and improved metabolic status through early warning, promoting self‐management and scientific blood sugar control, which is consistent with the research by Cao et al. 22
4. CONCLUSION
The combination of psychological intervention with a structured 1‐day outpatient management program may serve as a useful supplement to conventional GD care. This approach may help improve maternal psychological well‐being, enhance blood glucose self‐management, and potentially improve maternal and neonatal pregnancy outcomes, suggesting potential clinical value. Several limitations should be acknowledged. First, the nonrandomized group allocation may have introduced selection bias. Second, this was a single‐center study, which may limit the generalizability of the findings. Third, long‐term postpartum glycemic outcomes and long‐term psychological status were not evaluated. Future multicenter randomized controlled trials with larger sample sizes are warranted to further investigate the long‐term effectiveness of this management model.
AUTHOR CONTRIBUTIONS
Conception and design of the research: Zhanhong Shi, Yuedang Xu. Acquisition of data: Xiaofei Dong, Ye Zhang, Yanyan Yang. Analysis and interpretation of the data: Zhanhong Shi, Zeng Guo, Ye Zhang. Statistical analysis:Zeng Guo, Jieli Wu. Obtaining financing: Zhanhong Shi, Xiaofei Dong. Writing of the manuscript:Zhanhong Shi, Yuedang Xu. Critical revision of the manuscript for intellectual content: Jieli Wu, Yanyan Yang. All authors read and approved the final draft.
FUNDING INFORMATION
Wenzhou City Basic Medical and Health Technology Project (Y20210366).
CONFLICT OF INTEREST STATEMENT
All authors have contributed significantly to the manuscript and declare that the work is original and has not been submitted or published elsewhere. None of the authors have any financial disclosure or conflict of interest.
ETHICS APPROVAL AND CONSENT TO PARTICIPATE
This study was conducted in accordance with the declaration of Helsinki. This study was conducted with approval from the ethics committee of Wenzhou Central Hospital (K2021‐04‐068). Written informed consent was obtained from all participants.
DATA AVAILABILITY STATEMENT
Research data are not shared.
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Data Availability Statement
Research data are not shared.