title: Management of pregnant and postnatal women with pre-existing diabetes or cardiac disease using multi-disciplinary team models of care: a systematic review.
abstract: BACKGROUND
  More women with an increased risk of poor pregnancy outcome due to pre-existing medical conditions are becoming pregnant. Although clinical care provided through multi-disciplinary team (MDT) working is recommended, little is known about the structure or working practices of different MDT models, their impact on maternal and infant outcomes or healthcare resources. The objectives of this review were to consider relevant international evidence to determine the most appropriate MDT models of care to manage complex medical conditions during and after pregnancy, with a specific focus on pre-existing diabetes or cardiac disease in high income country settings.
  
  
  METHODS
  Quantitative and qualitative evidence of MDT models of care for the management of pregnant/postnatal women with pre-existing diabetes and cardiac disease was considered. A search of the literature published between January 2002 - January 2014 was undertaken. Methodological quality was assessed using checklists developed by the Joanna Briggs Institute. Given limited primary and secondary research evidence, guidelines and opinion papers were included. Two independent reviewers conducted critical appraisal of included papers.
  
  
  RESULTS
  Nineteen papers were included from UK, Canada, USA, the Netherlands and Singapore. No studies were found which had compared MDT models for pregnant/postnatal women with pre-existing diabetes or cardiac disease. Two small retrospective studies reported better outcomes for women with cardiac disease if an MDT approach was used, although evidence to support this was limited. Due to study heterogeneity it was not possible to meta-analyse data. No evidence was identified of MDT management in the postnatal period or impacts of MDT working on healthcare resources.
  
  
  CONCLUSIONS
  Despite widespread promotion of MDT models of care for pregnant and postnatal women with pre-existing diabetes or cardiac disease, there is a dearth of primary evidence to inform structure or working practices or beneficial impact on maternal and infant outcomes or healthcare resources. Primary research into if or how MDT models of care improve outcomes for women with complex pregnancies is urgently needed.
authors.affiliation: King's College London, Florence Nightingale Faculty of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK. debra.bick@kcl.ac.uk.
authors.forename: Debra
authors.initials: D
authors.lastname: Bick
authors.affiliation: King's College London, Florence Nightingale Faculty of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK. sarah.beake@kcl.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Beake
authors.affiliation: Women's Health Academic Centre, Guys and St Thomas' NHS Foundation Trust, 10th floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. lucy.chappell@kcl.ac.uk.
authors.forename: Lucy
authors.initials: L
authors.lastname: Chappell
authors.affiliation: Birmingham Centre for Women's and Children's Health, School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK. k.ismail@bham.ac.uk.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Ismail
authors.affiliation: Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK. david.mccance@belfasttrust.hscni.net.
authors.forename: David R
authors.initials: DR
authors.lastname: McCance
authors.affiliation: Whipps Cross Hospital, Barts NHS Trust, London, UK. james.green@bartshealth.nhs.uk.|Department of Health and Social Care, London South Bank University, London, UK. james.green@bartshealth.nhs.uk.
authors.forename: James S A
authors.initials: JS
authors.lastname: Green
authors.affiliation: King's College London, Florence Nightingale Faculty of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK. cath.taylor@kcl.ac.uk.
authors.forename: Cath
authors.initials: C
authors.lastname: Taylor
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration*; D011181:Postnatal Care; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000628:therapy*