Standardized Care Pathways Mitigate Occupational Disparities in Pregnancy Outcomes Among Nulliparous Women with Gestational Diabetes: A Propensity-Score-Matched Study

Objective This study aimed to determine whether employment status influences pregnancy outcomes in nulliparous women with gestational diabetes mellitus (GDM) who received standardized care. Methods We conducted a retrospective analysis of deliveries (2020–2024) at a tertiary hospital. To minimize parity-related confounding, the primary analysis was restricted to nulliparous women with GDM (n = 240). Propensity-score matching (1:1, caliper = 0.15) based on age, height, and pre-pregnancy BMI generated 62 matched employed–unemployed pairs. Continuous and categorical outcomes were compared using Student's t-test/Mann–Whitney U test and χ²/Fisher's exact test, respectively. Results In the full cohort (n = 595), employed women had a lower pre-pregnancy BMI than unemployed women (21.80 vs. 22.21 kg/m², p = 0.039). After matching, no significant differences were observed between groups in gestational weight gain (12.1 ± 3.8 kg vs. 11.3 ± 4.5 kg, p = 0.331), cesarean delivery rate (27.4% vs. 37.1%, p = 0.252), gestational age at delivery (39.3 vs. 39.2 weeks, p = 0.695), or fetal birth weight (3101 ± 365 vs. 3225 ± 353 g, p = 0.073). Conclusions Standardized, protocol-driven GDM care eliminated perinatal disparities associated with employment status, although a pre-pregnancy BMI gap persisted. Investment in equitable, high-quality antenatal programs may serve as an actionable strategy to advance health equity in GDM management by 2030.