Assessment of neonatologists' competency in managing gestational diabetes complications: a cross-sectional analysis from China

Abstract

Background: Gestational diabetes mellitus (GDM) significantly impacts long-term child health outcomes. This study assessed neonatologists' knowledge, attitudes, and practices (KAP) regarding GDM-related complications in offspring.

Methods: A cross-sectional study of 1,614 neonatologists in Hubei Province, China, utilized a validated 28-item questionnaire examining knowledge (12 items), attitudes (8 items), and practices (8 items). Responses were scored on a trichotomous scale. Binary logistic regression analyzed predictors of satisfactory performance across domains.

Results: Among 1,614 neonatologists, 1,437 (89%) demonstrated satisfactory knowledge, 1,513 (94%) positive attitudes, and 1,165 (72%) good practices. Knowledgeable practitioners were significantly older (45.4 vs 36.2 years; OR 1.42 [95% CI 1.40-1.44]; p<.001) with greater experience (13.8 vs 10.5 years; 1.41 [1.35-1.46]; p<.001). Academic hospital affiliation showed higher competency versus community settings (0.12 [0.08-0.20]; p<.001). Practice patterns varied by education, with MD-PhD holders demonstrating higher odds of good practice (1.32 [1.03-1.71]; P=.032) compared with fellowship training (0.69 [0.51-0.92]; p=.009). Universal documentation of maternal GDM coexisted with suboptimal rates of periodic evaluations (81%) and specialist referrals (84%). Knowledge competency (7.52 [5.90-9.60]; p<.001) and positive attitudes (15.81 [9.90-25.26]; p<.001) strongly predicted practice patterns.

Conclusions: Despite high knowledge levels and positive attitudes, particularly among experienced practitioners in academic settings, implementation gaps exist in follow-up protocols and specialist referrals. Practice setting significantly influences care delivery, suggesting the need for standardized protocols across healthcare tiers.

Keywords: China cardiomyopathy; KAP; alongside significantly; gestational diabetes mellitus; neonatology; prevalence.

Figure 1

Distribution of responses to all 28 items of knowledge, attitude, and practice (KAP) questionnaire administered to neonatologists (N = 1,614) regarding GDM-related neonatal and childhood complications. The knowledge domain (top) demonstrates overall high awareness, with lower recognition of lipid abnormalities and epigenetic mechanisms. The attitude and practice domains (middle and bottom) reflect strong endorsement of screening and interdisciplinary care but highlight notable deficits in routine follow-up scheduling, endocrinology referrals, and adherence to standardized postnatal protocols. All questionnaire items and response frequencies are fully represented in this figure.