IMPACT OF INTEGRATED CARE MODELS ON MATERNAL AND NEONATAL OUTCOMES IN PREGNANT WOMEN WITH ENDOCRINE DISORDERS: A SYSTEMATIC REVIEW

Abstract

Background: Integrated care models have been increasingly recognized for their role in improving maternal and neonatal outcomes in pregnant women with endocrine disorders such as gestational diabetes mellitus and hypothyroidism. These conditions pose significant risks, including hypertensive disorders, preterm birth, and neonatal complications. While various management strategies exist, the effectiveness of integrated, multidisciplinary care approaches remains inadequately synthesized in the literature. This systematic review addresses this gap by evaluating the impact of integrated care models on maternal and neonatal health outcomes.

Objective: This systematic review aims to assess the effectiveness of integrated care models in improving maternal and neonatal outcomes in pregnancies complicated by endocrine disorders compared to standard care.

Methods: A systematic review was conducted following PRISMA guidelines. Electronic databases, including PubMed, Scopus, Web of Science, and the Cochrane Library, were searched for studies published between 2019 and 2024. Inclusion criteria encompassed randomized controlled trials, cohort studies, and observational studies evaluating integrated care interventions in pregnant women with endocrine disorders. Studies focusing on gestational diabetes, hypothyroidism, and maternal obesity were included. Data extraction followed a standardized form, and the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale were used for quality assessment.

Results: Eight studies met the inclusion criteria, comprising 2,530 participants. Integrated care models demonstrated improved maternal outcomes, including reduced hypertensive disorders (p<0.05), lower preterm birth rates (p<0.01), and better glycemic control in gestational diabetes (p<0.05). Neonatal outcomes, such as lower rates of neonatal hypoglycemia and reduced neonatal intensive care unit admissions, were also observed (p<0.001). Studies on opioid-dependent pregnancies highlighted shorter neonatal hospital stays with integrated care (p<0.001).

Conclusion: The findings suggest that integrated care models significantly enhance maternal and neonatal outcomes in pregnancies complicated by endocrine disorders. These results support the integration of multidisciplinary approaches in clinical guidelines. However, variability in study designs necessitates further large-scale trials to validate these findings and assess long-term cost-effectiveness.