Cardiometabolic risk, knowledge, risk perception, and self-efficacy among American Indian women with previous gestational diabetes

Barriers to and enablers of type 2 diabetes screening among Indian and Chinese women with prior gestational diabetes: A qualitative study applying the Theoretical Domains Framework

PROBLEM

Women with previous gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2D).

BACKGROUND

In Australia, GDM and T2D prevalence are particularly high among Indian and Chinese women. Attendance for recommended postpartum T2D screening is low. Our aim was to identify modifiable barriers to, and enablers of, postpartum T2D screening among Chinese and Indian women with prior GDM in Australia, compare these to those of women with prior GDM from the general Australian population, and make culturally appropriate recommendations for intervention (messaging) content.

METHODS

Participants were recruited via the National Gestational Diabetes Register and social media platforms. Semi-structured interviews were conducted in March-May 2021. Using an inductive-deductive approach, data were coded to Theoretical Domains Framework (TDF) domains and mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model.

FINDINGS

Ten women participated: 6 Chinese born, 4 Indian born, nine of whom had previously screened for T2D. Nine influential TDF domains were identified, suggesting messaging content needs to address: Motivation (fear of T2D, encourage role modelling beliefs), Opportunity (encourage social support taking cultural and family norms into account), Capability (increase awareness of T2D risk, optimise prompts/reminders) CONCLUSIONS: Use of the COM-B and TDF suggests nine modifiable barriers to, and enablers of, postpartum T2D screening among Indian and Chinese-born women in Australia with prior GDM, mostly consistent with those of general Australian GDM populations. Culture-specific needs, such as including family in knowledge and support, and providing specific information regarding genetic- versus behaviour related risks can be accounted for within an inclusive messaging intervention addressing topics applicable to all women.

Polyphenols and Cardiometabolic Health: Knowledge and Concern among Romanian People

The cardiometabolic health of the population is a crucial indicator of public health, considering the significant impact of cardiovascular disease (CVD) and diabetes on global mortality. Determining the population's knowledge and the predictors of these pathologies is essential in developing effective educational and clinical strategies for the prevention and management of cardiometabolic risk (CMR). Polyphenols are natural compounds with a multitude of beneficial effects on cardiometabolic health. This study explored the current knowledge, understanding, and awareness of CMR, the benefits of polyphenols among Romanians, and how sociodemographic and clinical characteristics influence this aspect. Five hundred forty-six subjects responded anonymously to an online questionnaire designed to assess their knowledge. The data were collected and analyzed based on gender, age, education level, and BMI status. Most respondents expressed concern to a great or very great extent about their health (78%) and food (60%), with significant differences (p < 0.05) depending on age, educational level, and BMI status. Of the respondents, 64.8% declared that they were familiar with the CMR term. Still, the results showed a weak correlation between the stated risk factors and the self-assessment of increased risk (r = 0.027) for CVD or diabetes. Only 35% of the respondents reported a good or very good knowledge of the term "polyphenols", 86% recognized the antioxidant effect, and significantly fewer (26%) recognized the prebiotic effect. Developing and implementing targeted educational strategies to enhance learning and individual behaviors related to CMR factors and the benefits of polyphenols is necessary.

Indigenous Women's Perspectives on Heart Health and Well-being: A Scoping Review

Indigenous women tend to have higher rates of cardiovascular disease and/or stroke (CVD/s) and are less likely to report their health as good or excellent, in comparison to indigenous men. Cultural values and lived experiences of indigenous women can inform the relationship between them and their healthcare provider and their approaches to self-management of CVD/s. Health research often neglects to consider the subjective and cultural nature of health and well-being. A scoping review was conducted to identify available literature regarding indigenous women's perspectives on heart health. The research question for this scoping review was as follows: How do indigenous women who are at risk of and/or living with cardiovascular disease and stroke perceive their heart health and well-being? Database searches generated 4757 results, with an additional 37 articles identified from grey-literature depositories. A total of 378 articles were assigned a full-text review, of which 10 articles met the criteria for this analysis. The available literature provided evidence on how lifestyle, gender roles, relationships, mental and emotional health, health literature, culture, ceremony and healing, and experiences in the healthcare system impact the perspective that indigenous women have on heart health. Despite this population being at high risk for heart-related illnesses, indigenous women's perspectives on cardiovascular health and well-being continue to be underrepresented in the literature, warranting the need for culturally appropriate health policies informed by their lived experiences.

General Public's knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population

Background

Health literacy and illness perception play crucial roles in tackling the cardiometabolic disease epidemic. We aim to compare the attitudes, knowledge, self-perceived risks and actions taken, between individuals with and without metabolic risk factors (MFs).

Methods

From 5 June to 5 October 2022, participants of the general public were invited to complete a self-administered questionnaire. MF status was defined as the presence of hypertension, hyperlipidemia, diabetes mellitus and/or current/previous smoking. Participants were assessed based on four categories (knowledge-based, attitude-based, perceived risk, and action-based) of questions pertaining to four cardiometabolic diseases - diabetes mellitus, hypertension, hyperlipidemia, and non-alcoholic fatty liver disease.

Results

A total of 345 participants were enrolled, of whom 34.5% had at least one MF. Compared to those without MFs, participants with MFs had lower knowledge scores, but higher perceived risk scores across all cardiometabolic diseases. The largest knowledge gap pertained to hypertension-related questions. After adjustment, linear regression demonstrated that the presence of MFs (β:2.752, 95%CI: 0.772-4.733, p = 0.007) and higher knowledge scores (β:0.418, 95%CI: 0.236-0.600, p < 0.001) were associated with higher perceived risk. Despite increased perceived risk in those with MFs, this translated to only few increased self-reported preventive actions, when compared to those without MFs, namely the reduction in red meat/processed food consumption (p = 0.045) and increase in fruits/vegetables consumption (p = 0.009).

Conclusion

This study identified a vulnerable subpopulation living with MFs, with high perceived risks, and discordant levels of knowledge and preventive actions taken. Nationwide efforts should be channeled into addressing the knowledge-to-action gap.

Barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior gestational diabetes: A systematic review and qualitative synthesis applying the theoretical domains framework

AIMS

Racial and ethnic disparities exist in gestational diabetes prevalence and risk of subsequent type 2 diabetes mellitus (T2DM). Postpartum engagement in healthy behaviours is recommended for prevention and early detection of T2DM, yet uptake is low among women from diverse cultural backgrounds. Greater understanding of factors impacting postpartum health behaviours is needed. Applying the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation-Behaviour (COM-B) model, our aim was to synthesise barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior GDM and identify relevant intervention components.

METHODS

Databases, reference lists and grey literature were searched from September 2017 to April 2021. Two reviewers screened articles independently against inclusion criteria and extracted data. Using an inductive-deductive model, themes were mapped to the TDF and COM-B model.

RESULTS

After screening 5148 citations and 139 full texts, we included 35 studies (N = 787 participants). The main ethnicities included Asian (43%), Indigenous (15%) and African (11%). Barriers and enablers focused on Capability (e.g. knowledge), Opportunity (e.g. competing demands, social support from family, friends and healthcare professionals, culturally appropriate education and resources) and Motivation (e.g. negative emotions, perceived consequences and necessity of health behaviours, social/cultural identity). Five relevant intervention functions are identified to link the barriers and enablers to evidence-based recommendations for communications to support behaviour change.

CONCLUSIONS

We provide a conceptual model to inform recommendations regarding the development of messaging and interventions to support women from diverse cultural backgrounds in engaging in healthy behaviours to reduce risk of T2DM.

Cardiovascular Diseases Healthy Diet Related Knowledge among a Sample of the General Population in Egypt

BACKGROUND: Little is known about the extent of Egyptians’ awareness regarding the relationship between nutrition and cardiovascular health. AIM: This study seeks to evaluate people’s awareness through an online cross-sectional survey to determine the knowledge gaps. METHODS: This cross-sectional study was conducted through an online survey using a convenience sampling technique. The participation required being an adult Egyptian (≥18 years old). A pre-tested electronic-questionnaire included three sections: Socio-demographic data, a self-reported history of chronic and cardiac diseases, and 15 questions addressing dietary risk factors and protective factors. Six hundred and thirty-two participants completed the questionnaire. RESULTS: The mean age was 28 ± 8 years. More than 80% of the participants were males. Of 632 participants, 233 had poor awareness. The median knowledge percent score was 62 with interquartile range (52, 71). About 85.4% of the participants were ready to change their eating habits and follow a healthy diet to maintain their health. The participants were interested in knowing more about healthy food and how to prepare healthy balanced meals (71.7% and 62.2%, respectively). Females, university-educated, employed, and Upper Egypt residents demonstrated deep awareness (p-value = 0.02, 0.011, 0.05, and 0.012, respectively). Intriguingly, friends and social media were the primary sources of nutritional knowledge. CONCLUSION: The participants’ knowledge is poor regarding the relation between nutrition and cardiovascular health. This study emphasizes the urgent need to raise public awareness as a precaution against cardiovascular diseases.

"Would You Rather Jump Out of a Perfectly Good Airplane or Develop Cardiovascular Disease?" Validity and Reliability of the Cardiovascular Risk Perception Survey Among Military Personnel

BACKGROUND AND PURPOSE

Cardiovascular disease (CVD) is a major cause of death in the United States. The military are viewed as fit, ready to fight and that jumping out of perfectly good airplane or going to war is a greater risk than CVD. The purpose of this study was to determine reliability and validity of the Cardiovascular Risk Perception Survey (CRPS).

METHODS

A cross-sectional descriptive design was performed, supported by the Health Belief Model. Internal consistency reliability (Cronbach's alpha) and validity (principal component analysis) were examined.

RESULTS

Fifty-five participants were included in this study. Construct validity of the CRPS was supported by principal component analysis; indicating one scale that measured cardiovascular risk perception. The Cronbach's alpha is reported .865.

CONCLUSION

Initial psychometric testing of the CRPS provides evidence for construct validity and internal consistency reliability.

Communication With American Indians and Alaska Natives About Cardiovascular Disease

INTRODUCTION

Cardiovascular disease (CVD) is the leading cause of death among American Indians and Alaska Natives. Reducing CVD risk requires effective communication about risk factors and preventive behaviors. Messages should be designed with an understanding of where people seek health information, their perceptions of a hazard, and their perception of information sufficiency. We examined these components of message design to inform strategies to effectively communicate information about CVD to American Indians and Alaska Natives.

METHODS

We surveyed 220 adults who self-identified as American Indians or Alaska Natives at 2 Native-focused events in urban areas. Our survey included items on demographic characteristics, place of residence, sources of information used to learn about CVD, perceived information sufficiency, and perceptions about the importance of CVD as a health problem.

RESULTS

Respondents used the internet (67%), their doctors (66%), friends and relatives (63%), brochures (62%), and television (61%) to learn about CVD. Participants aged 60 or older and those living on a reservation were more likely to use their doctor to learn about CVD than their younger (≤30 y) or urban peers. CVD was viewed as a major problem for American Indians and Alaska Natives (84%) and for Americans in general (86%). Most respondents felt moderately (54%) or well informed (37%) about CVD.

CONCLUSION

Various information sources should be used to increase awareness about CVD. Special attention may be needed to optimize communication to American Indians and Alaska Natives aged 60 or older and people living on reservations. Further study is needed to determine how our findings can best inform effective interventions to reduce CVD morbidity and mortality among these populations.

Risk perception of developing diabetes: A concept analysis

BACKGROUND

Cognitive risk perception has been linked to health behavior needed to reduce the risk of developing type 2 diabetes. The concept of risk perception of developing diabetes needed review due to: (a) frequent lack of congruency between perceived and actual risk of developing diabetes, and (b) inconsistent measures for calculating perceived diabetes risk.

DESIGN

The concept analysis was conducted using the Walker and Avant approach.

DATA SOURCES

Dictionary definitions, thesaurus synonyms and antonyms, theoretical sources, and seminal works related generally to risk perception were reviewed. Database searches for studies conducted in the United States measuring perceived risk of developing diabetes, were conducted in PubMed, Embase, and CINAHL; resulting in the selection and review of 23 research articles.

RESULTS

The identified dimensions of perceived diabetes risk were: perceived likelihood, personal risk, general risk, cognitive, emotional, comparative risk, and unrealistic optimism. Some antecedents of perceived diabetes risk were motivational factor, individual difference, contextual factor, cognitive factor, and affective factor. A consequence of perceived diabetes risk was health-promoting behaviors.

CONCLUSIONS

This concept analysis increases clarity of a multidimensional concept, providing a basis for validity for measurements. Consideration of antecedents for perceived diabetes risk will be important as related to diabetes prevention efforts.

Knowledge and Health Beliefs of Gestational Diabetes Mellitus Associated with Breastfeeding Intention Among Pregnant Women in Bangladesh

PURPOSE

This study aimed to investigate the knowledge of gestational diabetes mellitus (GDM) and the health beliefs about GDM management, as well as to investigate the effects of these factors on breastfeeding intention in Bangladesh.

METHODS

This study involved a cross-sectional survey of 358 healthy pregnant women who visited antenatal clinics in Bangladesh.

RESULTS

Perceived susceptibility, perceived benefit, and self-efficacy were identified as significant factors for breastfeeding intention (p < .05). Participants had a poor understanding and a lack of knowledge of GDM, which can lead to inadequate health behavior. Health beliefs were significantly associated with participants' breastfeeding intention related to GDM.

CONCLUSION

Antenatal education for breastfeeding in GDM mothers should focus on providing accurate information on GDM and strengthening their health beliefs such as self-efficacy within the context of the mothers' culture.

Women's views on lifestyle changes to reduce the risk of developing Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice

AIMS

After gestational diabetes, many women exhibit behaviours that increase their risk of developing Type 2 diabetes. We aimed to systematically synthesize the literature that focuses on the views of women with a history of gestational diabetes on reducing their risk of developing diabetes postpartum through lifestyle and behaviour changes.

METHODS

We identified qualitative studies that examined the views of women with a history of gestational diabetes towards healthy eating and physical activity, Type 2 diabetes risk management or their experience of a diabetes prevention programme, and conducted a thematic synthesis to develop descriptive and then analytical themes. We also evaluated the quality of each study and the confidence that we had in our findings.

RESULTS

We included 21 articles after screening 23 160 citations and 129 full texts. We identified six themes of interacting influences on postpartum behaviour: role as mother and priorities; social support; demands of life; personal preferences and experiences; risk perception and information; and finances and resources (plus preferred format of interventions). These factors inhibited many women from addressing their own health, while they motivated others to persevere. We also developed 20 recommendations, most with high or moderate confidence, for effective promotion of healthy lifestyles in this population.

CONCLUSIONS

Many factors hinder healthy lifestyles after gestational diabetes, yet how women interpret them can motivate or prevent changes that reduce diabetes risk. As our recommendations emphasize, women's experiences and needs should be considered when designing strategies to promote healthier lifestyles in this population.

Knowledge and health beliefs about gestational diabetes and healthy pregnancy's breastfeeding intention

AIMS AND OBJECTIVES

If the knowledge and health beliefs relating to gestational diabetes mellitus during pregnancy are associated with behaviours during pregnancy and lactation, this suggests potential educational interventions.

BACKGROUNDS

Women with gestational diabetes mellitus are more likely to develop type 2 diabetes mellitus, and babies with gestational diabetes mellitus incur increased risk of neonatal hypoglycaemia and childhood obesity. Breastfeeding is an effective way to improve maternal and lipid metabolism of gestational diabetes mothers, and to lower the risk of type 2 diabetes mellitus after birth, to prevent conception. Nurses have an important role in encouraging mothers to breastfeed for health promotion. The importance of cognitive factors such as knowledge, beliefs and attitudes is emphasised to increase the breastfeeding rate and to improve the quality of breastfeeding for pregnant women. Little research has been undertaken exploring cognitive factors and breastfeeding intention.

DESIGN

Cross-sectional descriptive survey in healthy pregnant women.

METHODS

A questionnaire about gestational diabetes mellitus-related knowledge and health beliefs of gestational diabetes mellitus management composed of perceived susceptibility, severity, benefits, barriers and self-efficacy was developed by investigators. The association of two predictor variables of interest, gestational diabetes mellitus-related knowledge and health beliefs of gestational diabetes mellitus management, was tested with the outcome variable, breastfeeding intention, using chi-square test, t test, ANOVA and multiple logistic regression.

RESULTS

Two hundred and thirty-seven of the 250 participants returned questionnaires for a final response rate of 94.8%. Breastfeeding intention after childbirth was associated with stronger perceived benefit, higher levels of self-efficacy and lower alcohol consumption.

CONCLUSION

History of drinking and health beliefs such as perceived benefits and self-efficacy were highly associated with breastfeeding intention relating to gestational diabetes mellitus. Education for breastfeeding in gestational diabetes mellitus mothers should focus upon the benefit of breastfeeding and strengthening self-efficacy.

How are health-related behaviours influenced by a diagnosis of pre-diabetes? A meta-narrative review

BACKGROUND

Several countries, including England, have recently introduced lifestyle-focused diabetes prevention programmes. These aim to reduce the risk of individuals with pre-diabetes developing type 2 diabetes. We sought to summarise research on how socio-cultural influences and risk perception affect people's behaviour (such as engagement in lifestyle interventions) after being told that they have pre-diabetes.

METHODS

Using the RAMESES standards for meta-narrative systematic reviews, we identified studies from database searches and citation-tracking. Studies were grouped according to underlying theorisations of pre-diabetes. Following a descriptive analysis, the studies were synthesised with reference to Cockerham's health lifestyle theory.

RESULTS

In total, 961 titles were scanned, 110 abstracts assessed and 35 full papers reviewed. Of 15 studies included in the final analysis, 11 were based on individual interviews, focus groups or ethnography and five on structured questionnaires or surveys. Three meta-narratives emerged. The first, which we called biomedical, characterised pre-diabetes as the first stage in a recognised pathophysiological illness trajectory and sought to intervene with lifestyle changes to prevent its progression. The second, which we called psychological, focused on the theory-informed study of the knowledge, attitudes and behaviours in people with pre-diabetes. These studies found that participants generally had an accurate perception of their risk of developing diabetes, but this knowledge did not directly lead to behavioural change. Some psychological studies incorporated wider social factors in their theoretical models and sought to address these through action at the individual level. The third meta-narrative we termed social realist. These studies conceptualised pre-diabetes as the product of social determinants of health and they applied sociological theories to explore the interplay between individual agency and societal influences, such as the socio-cultural context and material and economic circumstances. They recommended measures to address these structural influences on lifestyle choices.

CONCLUSIONS

The study of pre-diabetes to date has involved at least three research disciplines (biomedicine, psychology and sociology), which up to now have operated largely independently of one another. Behavioural science and sociology are increasing our understanding of how personal, social, cultural and economic aspects influence health-related behaviours. An interdisciplinary approach with theoretically informed multi-level studies could potentially improve the success of diabetes prevention strategies.

TRIAL REGISTRATION

Prospero Registration Number: CRD42018088609 .

Prevention of Type 2 diabetes after gestational diabetes directed at the family context: a narrative review from the Danish Diabetes Academy symposium

In this review, we aim to summarize knowledge about gestational diabetes mellitus (GDM) after delivery; with special focus on the potential of preventing Type 2 diabetes in a family context. The review expands on the key messages from a symposium held in Copenhagen in May 2017 and highlights avenues for future research. A narrative review of the symposium presentations and related literature is given. GDM is associated with increased short- and long-term adverse outcomes including Type 2 diabetes for both mother and offspring. Interestingly, GDM in mothers also predicts diabetes in the fathers. Thus, although GDM is diagnosed in pregnant women, the implications seem to affect the whole family. Structured lifestyle intervention can prevent or delay the onset of Type 2 diabetes. In this review, we show how numerous challenges are present in the target group, when such interventions are sought and implemented in real-world settings. Although interlinked and interacting, barriers to maintaining a healthy lifestyle post-partum can be grouped into those pertaining to diabetes beliefs, the family context and the healthcare system. Health literacy level and perceptions of health and disease risk may modify these barriers. There is a need to identify effective approaches to health promotion and health service delivery for women with prior GDM and their families. Future efforts may benefit from involving the target group in the development and execution of such initiatives as one way of ensuring that approaches are tailored to the needs of individual women and their families.

Appreciating Recent Motherhood and Culture: A Systematic Review of Multimodal Postpartum Lifestyle Interventions to Reduce Diabetes Risk in Women with Prior Gestational Diabetes

Objectives Gestational diabetes mellitus (GDM) substantially increases a woman's lifetime risk of developing type 2 diabetes mellitus (DM). Lifestyle modification interventions have been effective in preventing DM in high-risk populations but present challenges in diverse, postpartum women. We systematically reviewed the literature to synthesize current knowledge and practices around tailoring multimodal, primarily home-based interventions for situational and cultural relevance to reduce DM risk in women with prior GDM. Methods We identified original research articles published from January 2000 through July 2015 describing randomized controlled trials testing multimodal interventions to reduce DM risk in women with prior GDM. We compared articles by study objective, delivery modes, intervention components, degree of individualization, theoretical basis, design, population, outcome variables, and findings. Results Ten studies met the inclusion criteria. Telephone and mailings (n = 7) and websites (n = 3) were the primary modes of participant contact in these primarily home-based interventions. These studies demonstrate that individualizing interventions may contribute to increased postpartum weight loss and improved dietary behaviors; however, researchers remain challenged to improve physical activity in this population. Additionally, even when testing primarily home-based interventions, recruitment rates were very low, underscoring challenges of engaging this population in lifestyle changes. Conclusions Postpartum interventions addressing the broader social-ecological dimensions of health behaviors should be tested in women with prior GDM. Researchers and clinicians must continue to explore ways to engage women, including women's families and communities, in interventions to adequately address the sociocultural determinants that affect women's lifestyle behaviors impacting their DM risk.

The Impact of Health Education Intervention for Prevention and Early Detection of Type 2 Diabetes in Women with Gestational Diabetes

This study aims to investigate the impact of a health belief model (HBM)-based educational intervention on knowledge, beliefs, self-reported practices, gestational and postpartum weight in women with gestational diabetes mellitus (GDM).

SUBJECTS AND METHODS

A cluster randomized controlled trial was performed, with randomization at the level of Primary Health Care centers in three Egyptian cities. Eligible women with GDM were enrolled at 24 weeks pregnancy. The intervention group (n = 103) received health education intervention based on the HBM construct. Control subjects (n = 98) received the usual care. The outcomes measured were: women's knowledge, beliefs, self-reported practices, gestational weight gain (GWG), and postpartum weight retention. Patients were investigated at baseline, at end of pregnancy, and at 6 weeks postpartum.

RESULTS

After the intervention, percentages of women who had high knowledge and beliefs scores had significantly increased from less than 50 % to more than 70 % in the intervention group (p < 0.001). More women in the intervention group reported practicing exclusive breast feeding (85.4 %) and screening for T2DM (43.7 %) at 6 weeks postpartum compared to the control group (63.3 and 19.4 % respectively) (p < 0.001). More women with excessive body mass index in the intervention group (65 %) compared to the control group (11.6 %) were meeting recommended GWG (p < 0.001), and postpartum weight (37.7, and 20.3 % respectively) (p < 0.01).

CONCLUSION

This intervention significantly improved knowledge, beliefs, self-reported practices, and gestational and postpartum weight in patients with GDM. Further research is needed for investigating the effectiveness of applying early, multi-phase, and longer intervention.

Paths to improving care of Australian Aboriginal and Torres Strait Islander women following gestational diabetes

Aim To understand enablers and barriers influencing postpartum screening for type 2 diabetes following gestational diabetes in Australian Indigenous women and how screening might be improved.

BACKGROUND

Australian Indigenous women with gestational diabetes mellitus (GDM) are less likely than other Australian women to receive postpartum diabetes screening. This is despite a fourfold higher risk of developing type 2 diabetes within eight years postpartum.

METHODS

We conducted interviews with seven Indigenous women with previous GDM, focus groups with 20 Indigenous health workers and workshops with 24 other health professionals. Data collection included brainstorming, visualisation, sorting and prioritising activities. Data were analysed thematically using the Theoretical Domains Framework. Barriers are presented under the headings of 'capability', 'motivation' and 'opportunity'. Enabling strategies are presented under 'intervention' and 'policy' headings. Findings Participants generated 28 enabling environmental, educational and incentive interventions, and service provision, communication, guideline, persuasive and fiscal policies to address barriers to screening and improve postpartum support for women. The highest priorities included providing holistic social support, culturally appropriate resources, improving Indigenous workforce involvement and establishing structured follow-up systems. Understanding Indigenous women's perspectives, developing strategies with health workers and action planning with other health professionals can generate context-relevant feasible strategies to improve postpartum care after GDM. Importantly, we need evidence which can demonstrate whether the strategies are effective.

Diabetes prevention among American Indians: the role of self-efficacy, risk perception, numeracy and cultural identity

Background

According to the Risk Perception Attitude (RPA) framework, classifying people according to their perceptions of disease risk and their self-efficacy beliefs allows us to predict their likelihood for engaging in preventive behaviors. Health interventions can then be targeted according to RPA group. We applied the framework to type 2 diabetes prevention behaviors among American Indians and expanded it to include culture and numeracy.

Methods

Using a cross-sectional study design, we surveyed a sample of Northern Plains American Indians in a reservation community setting on self-reported perceptions of diabetes risk, objective diabetes risk, self-efficacy, engagement in healthy behaviors, knowledge of diabetes risk factors, and covariates including demographics, numeracy, and cultural identity. We used the RPA framework to classify participants into four groups based on their perceptions of risk and self-efficacy. Analyses of variance and covariance estimated inter-group differences in behaviors associated with type 2 diabetes prevention.

Results

Among 128 participants, our only finding consistent with the RPA framework was that self-efficacy and risk perception predicted knowledge about diabetes risk factors. We found limited evidence for the influence of cultural identity within the RPA framework. Overall, participants had lower numeracy skills which tended to be associated with inaccurate perceptions of higher levels of risk.

Conclusions

The theoretical framework may benefit from inclusion of further contextual factors that influence these behaviors. Attention to numeracy skills stands out in our study as an important influence on the RPA framework, highlighting the importance of attending to numeracy when targeting and tailoring risk information to participants segmented by the RPA framework.

Low rates of predominant breastfeeding in hospital after gestational diabetes, particularly among Indigenous women in Australia

OBJECTIVES

To investigate rates of 'any' and 'predominant' breastfeeding in hospital among Indigenous and non-Indigenous women with and without gestational diabetes mellitus (GDM).

METHODS

A retrospective study of singleton infants born from July 2007 to December 2010 at Cairns Hospital, Australia, following GDM pregnancy, using linked hospital and birth data (n=617 infants), with a subsample of medical record reviews (n=365 infants). Aggregate data were used to compare to breastfeeding rates among infants born following non-GDM pregnancy (n=7,894 infants).

RESULTS

More than 90% of all women reported any breastfeeding before hospital discharge. About 80% of women without GDM reported predominant breastfeeding. Despite significant increases over time (p<0.0001), women with GDM were less likely to predominantly breastfeed (OR 0.32, 95%CI 0.27-0.38, p<0.0001); with lower rates among Indigenous women (53%) compared with non-Indigenous (60%) women (OR 0.78, 0.70-0.88, p<0.0001); and women having a caesarean birth or pre-term infant.

CONCLUSIONS

Rates of predominant in-hospital breastfeeding were lower among women with GDM, particularly among Indigenous women and women having a caesarean or pre-term birth.

IMPLICATIONS

Strategies are needed to support predominant in-hospital breastfeeding among women with GDM.

Validation of the Knowledge and Perception of Cardiovascular Risk Factors Questionnaires for College Students

BACKGROUND AND PURPOSE

To test the psychometric properties of two measures of knowledge and perception of cardiovascular risk factors (CRFs).

METHODS

A methodological study using a modified version of the Heart Disease Fact Questionnaire (HDFQ) and the Health Beliefs Related to Cardiovascular Disease (HBCVD) questionnaires was administered to 100 college-aged students.

RESULTS

The HDFQ Kuder-Richardson-20 reliability estimate was .73. The HBCVD Cronbach's alpha was .70. Principal component analysis demonstrated the HBCVD questions load onto components representing the perceived susceptibility and severity of CRFs. There was an inverse relationship between knowledge and perception of CRFs (ρ = -.26, p = .009), as knowledge increased, perception of risk decreased.

CONCLUSIONS

The HDFQ and HBCVD questionnaires had adequate internal consistency reliability and documented construct validity for use in college students.

Risk perception in pregnancy: a concept analysis

AIM

To report an analysis of the concept of risk perception in pregnancy.

BACKGROUND

Pregnant women are increasingly exposed to the view that pregnancy and childbirth are intrinsically dangerous, requiring medical monitoring and management. Societal pressures are applied to women that dictate appropriate behaviours during pregnancy. These changes have resulted in increased perception of risk for pregnant women.

DESIGN

Walker and Avant's method was selected to guide this analysis.

DATA SOURCES

Peer-reviewed articles published in English from CINAHL, Scopus, PubMed and Psychinfo. No date limits were applied.

METHODS

Thematic analysis was conducted on 79 articles. Attributes, antecedents and consequences of the concept were identified.

RESULTS

The attributes of the concept are the possibility of harm to mother or infant and beliefs about the severity of the risk state. The physical condition of pregnancy combined with the cognitive ability to perceive a personal risk state is antecedents. Risk perception in pregnancy influences women's affective state and has an impact on decision-making about pregnancy and childbirth. There are limited empirical referents with which to measure the concept.

CONCLUSION

Women today know more about their developing infant than at any other time in history; however, this has not led to a sense of reassurance. Nurses and midwives have a critical role in assisting pregnant women, and their families make sense of the information they are exposed to. An understanding of the complexities of the concept of risk perception in pregnancy may assist in enabling nurses and midwives to reaffirm the normalcy of pregnancy.

Perspectives on prevention of type 2 diabetes after gestational diabetes: a qualitative study of Hispanic, African-American and White women

Women with gestational diabetes (GDM) have a fivefold higher risk of developing type 2 diabetes (T2DM). Furthermore, Hispanic and African-American women are disproportionately affected by GDM, but their views on prevention of T2DM after gestational diabetes are largely unknown. We conducted semi-structured interviews with 23 women (8 Hispanic, 8 African-American, 7 non-Hispanic White) from two academic clinics in Chicago, IL. Interview questions elicited perspectives on prevention of T2DM; the interview protocol was developed based on the Health Belief Model. Two investigators applied template analysis to identify emergent themes. Women conceptualized risk for T2DM based on family history, health behaviors, and personal history of GDM. A subgroup of women expressed uncertainty about how GDM influences risk for T2DM. Women who described a strong link between GDM and T2DM often viewed the diagnosis as a cue to action for behavior change. T2DM was widely viewed as a severe condition, and desire to avoid T2DM was an important motivator for behavior change. Children represented both a key motivator and critical barrier to behavior change. Women viewed preventive care as important to alert them to potential health concerns. Identified themes were congruent across racial/ethnic groups. Diagnosis with GDM presents a potent opportunity for engaging women in behavior change. To fully harness the potential influence of this diagnosis, healthcare providers should more clearly link the diagnosis of GDM with risk for future T2DM, leverage women's focus on their children to motivate behavior change, and provide support with behavior change during healthcare visits in the postpartum period and beyond.

Risk perception for diabetes in Appalachian women

The social and economic burden of diabetes is large and growing. Diabetes is a significant public health issue in the Appalachian region; women constitute approximately 50% of those diagnosed with diabetes. This cross-sectional study examined the relationship among sociodemographic, anthropometric, lifestyle, and psychosocial factors (cognitive and affective representations) and perceived risk of diabetes in non-diabetic, non-elderly (21-50 years) Appalachian women residing in West Virginia (N = 202). Participants were recruited through social media, flyers, and a newsletter from the West Virginia University Extension. The final survey was conducted from March 2015 to June 2015. Bivariate analyses were used to examine unadjusted relations among sociodemographic, anthropometric, lifestyle, and psychosocial factors and comparative perceived risk of diabetes. In a multivariable logistic regression model, we found that younger age, higher body mass index, non-White race, greater diabetes knowledge, personal control, and moderate amounts of physical activity were significantly, positively associated with higher diabetes risk perception (p < .05). Our results indicated that diabetes knowledge, personal control, and physical activity were related to diabetes risk perception among Appalachian women. Understanding perceived diabetes-related risk may aid in the development of effective intervention strategies to reduce the burden of diabetes among Appalachian and other populations. These cross-sectional findings need further evaluation in longitudinal studies.

Systematic Review of Interventions for Racial/Ethnic-Minority Pregnant Smokers

INTRODUCTION

Large disparities exist in smoking rates during pregnancy by racial/ethnic status.

AIMS

The current review examined controlled studies that predominantly included racial/ethnic-minority pregnant smokers for providing smoking cessation treatment.

METHODS

Two authors independently conducted the literature searches in the standard databases using a combination of the keywords with minority, pregnancy, smoking, and cessation identifiers.

RESULTS

The searches identified nine articles that met the inclusion criteria. Only two studies exclusively targeted specific minority groups. Most of them provided some form of brief smoking cessation counseling, with two combining with incentives and one combining with pharmacotherapy. Two studies provided intensive cognitive interventions. Pregnant smokers of American Indian or Alaska Native, Hispanic subgroups, and Asian or Pacific Islander are under-studied.

CONCLUSIONS

Future studies to treat minority pregnant smokers could target under-studied minority groups and may need to directly and intensely target smoking behavior, address cultural and psychosocial issues in an individualized and comprehensive manner, and analyze cost-benefit of an intervention.

Type 2 diabetes after gestational diabetes: greater than fourfold risk among Indigenous compared with non-Indigenous Australian women

BACKGROUND

Gestational diabetes is associated with a high risk of type 2 diabetes. However, progression rates among Indigenous women in Australia who experience high prevalence of gestational diabetes are unknown.

METHODS

This retrospective cohort study includes all births to women at a regional hospital in Far North Queensland, Australia, coded as having 'gestational diabetes' from 1 January 2004 to 31 December 2010 (1098 births) and receiving laboratory postpartum screening from 1 January 2004 to 31 December 2011 (n = 483 births). Women who did not receive postpartum screening were excluded from the denominator. Data were linked between hospital electronic records, routinely collected birth data and laboratories, with sample validation by reviews of medical records. Analysis was conducted using Cox-proportional regression models.

RESULTS

Indigenous women had a greater than fourfold risk of developing type 2 diabetes within 8 years of having gestational diabetes, compared with non-Indigenous women (hazards ratio 4.55, 95% confidence interval 2.63-7.88, p < 0.0001). Among women receiving postpartum screening tests, by 3, 5 and 7 years postpartum, 21.9% (15.8-30.0%), 25.5% (18.6-34.3%) and 42.4% (29.6-58.0%) Indigenous women were diagnosed with type 2 diabetes after gestational diabetes, respectively, compared with 4.2% (2.5-7.2%), 5.7% (3.3-9.5%) and 13.5% (7.3-24.2%) non-Indigenous women. Multivariate analysis showed an increased risk of developing type 2 diabetes among women with an early pregnancy body mass index ≥25 kg/m(2) , only partially breastfeeding at hospital discharge and gestational diabetes diagnosis prior to 17 weeks gestation.

CONCLUSIONS

This study demonstrates that, compared with non-Indigenous women, Indigenous Australian women have a greater than fourfold risk of developing type 2 diabetes after gestational diabetes. Strategies are urgently needed to reduce rates of type 2 diabetes by supporting a healthy weight and breastfeeding and to improve postpartum screening among Indigenous women with gestational diabetes. Copyright © 2015 John Wiley & Sons, Ltd.

Identifying postpartum intervention approaches to reduce cardiometabolic risk among American Indian women with prior gestational diabetes, Oklahoma, 2012-2013

Introduction

Innovative approaches are needed to reduce cardiometabolic risk among American Indian women with a history of gestational diabetes. We assessed beliefs of Oklahoma American Indian women about preventing type 2 diabetes and cardiovascular disease after having gestational diabetes. We also assessed barriers and facilitators to healthy lifestyle changes postpartum and intervention approaches that facilitate participation in a postpartum lifestyle program.

Methods

In partnership with a tribal health system, we conducted a mixed-method study with American Indian women aged 19 to 45 years who had prior gestational diabetes, using questionnaires, focus groups, and individual interviews. Questionnaires were used to identify women’s cardiometabolic risk perceptions and feasibility and acceptability of Internet or mobile phone technology for delivery of a postpartum lifestyle modification program. Focus groups and individual interviews were conducted to identify key perspectives and preferences related to a potential program.

Results

Participants were 26 women, all of whom completed surveys; 11 women participated in focus group sessions, and 15 participated in individual interviews. Most women believed they would inevitably develop diabetes, cardiovascular disease, or both; however, they were optimistic that they could delay onset with lifestyle change. Most women expressed enthusiasm for a family focused, technology-based intervention that emphasizes the importance of delaying disease onset, provides motivation, and promotes accountability while accommodating women’s competing priorities.

Conclusions

Our findings suggest that an intervention that uses the Internet, text messaging, or both and that emphasizes the benefits of delaying disease onset should be tested as a novel, culturally relevant approach to reducing rates of diabetes and cardiovascular disease in this high-risk population.

Associations with low rates of postpartum glucose screening after gestational diabetes among Indigenous and non-Indigenous Australian women

OBJECTIVES

To explore factors associated with postpartum glucose screening among women with Gestational Diabetes Mellitus (GDM).

METHODS

A retrospective study using linked records from women with GDM who gave birth at Cairns Hospital in Far North Queensland, Australia, from 1 January 2004 to 31 December 2010.

RESULTS

The rates of postpartum Oral Glucose Tolerance Test (OGTT) screening, while having increased significantly among both Indigenous* and non-Indigenous women from 2004 to 2010 (HR 1.15 per year, 95%CI 1.08-1.22, p<0.0001), remain low, particularly among Indigenous women (10% versus 27%, respectively at six months postpartum). Indigenous women in Cairns had a longer time to postpartum OGTT than Indigenous women in remote areas (HR 0.58, 0.38-0.71, p=0.01). Non-Indigenous women had a longer time to postpartum OGTT if they: were born in Australia (HR 0.76, 0.59-1.00, 0.05); were aged <25 years (HR 0.45, 0.23-0.89, p=0.02); had parity >5 (HR 0.33, 0.12-0.90, p=0.03); smoked (HR 0.48, 0.31-0.76, p=0.001); and did not breastfeed (HR 0.09, 0.01-0.64, p=0.02).

CONCLUSIONS

Postpartum diabetes screening rates following GDM in Far North Queensland are low, particularly among Indigenous women, with lower rates seen in the regional centre; and among non-Indigenous women with indicators of low socioeconomic status.

IMPLICATIONS

Strategies are urgently needed to improve postpartum diabetes screening after GDM that reach women most at risk.

Cardiovascular diseases and women: knowledge, attitudes, and behavior in the general population in Italy

Background. The objectives of the study were to document knowledge, attitudes, and behaviors of women regarding cardiovascular diseases (CVDs) and the determinants associated. Materials and Methods. The cross-sectional survey was conducted among a random sample of 830 women older than 18 years from the general population in Italy. Results. Almost all participants reported having heard about CVDs, and among them 89.4% and 74.7% identified smoking and high cholesterol level as risk factors. Only 26.5% identified the main CVDs risk factors. Women more knowledgeable were married and better educated and self-perceived a worse health status. Only 23% knew the main CVDs preventive measures and this knowledge was significantly higher in women who are unemployed, who are more educated, who have received information about CVDs from physicians, and who know the main risk factors. Respondents with lower education, those with at least three children, those who self-perceived a worse health status, and those who need information were most likely to have a positive attitude toward the perceived risk of developing CVDs. Women with two or three children or more were at high risk profiles 49% and 56% lower than women with one child. Conclusions. Educational programs are needed among women as support to improve knowledge and appropriate behavior about CVDs.

'Change means sacrificing a good life': perceptions about severity of type 2 diabetes and preventive lifestyles among people afflicted or at high risk of type 2 diabetes in Iganga Uganda

BACKGROUND

Interventions for prevention of type 2 diabetes ought to be acceptable to target communities. We assessed perceptions about type 2 diabetes and lifestyle change among people afflicted or at high risk of this disease in a low income setting in Iganga Uganda.

METHODS

Twelve focus group discussions (FGDs) of eight participants each were conducted, balancing rural and peri-urban (near the Municipality) residence and gender. The FGDs involved people with suspected type 2 diabetes (based on fasting plasma glucose (FPG), people with suspected pre-diabetes and obese people with normal FPG. Content analysis was conducted.

RESULTS

Diabetes was perceived to be a very severe disease. Its severity was attributed to its incurability and its numerous health effects. Men were also concerned about reduced sexual performance. However, participants' strong concerns about the severity of diabetes were not reflected in their perceptions about the risk factors and lifestyles associated with it. While people with diabetes perceive obesity as 'sickness', those without diabetes perceive it as a sign of 'success'. Although participants are willing to change their diet, they mention numerous barriers including poverty, family size, and access to some foods. Because of their good taste, reduction of high risk foods like sugar and fried food is perceived as 'sacrificing a good life'. Increments in physical activity were said to be feasible, but only in familiar forms like domestic work. An over-arching theme emerged that 'lifestyle changes are viewed as sacrificing a good life'.

CONCLUSIONS

Health promotion should target both community norms and individual awareness regarding obesity, physical activity and diet, and should address the notion that obesity and unhealthy foods represent a good life. Health educators should plan with clients on how to overcome barriers and misconceptions to lifestyle change, leveraging the pervasive perception of type 2 diabetes as a severe disease to motivate change.

Experiences and perceptions about cause and prevention of cardiovascular disease among people with cardiometabolic conditions: findings of in-depth interviews from a peri-urban Nepalese community

BACKGROUND

Nepal currently faces an increasing burden of cardiovascular disease (CVD). Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice.

OBJECTIVE

This qualitative study aimed to deepen understanding of the community perspective on cardiovascular health from the patients' viewpoint.

DESIGN

We conducted in-depth interviews (IDIs) with 13 individuals with confirmed heart disease, hypertension, or diabetes mellitus. All participants provided verbal consent. We used an IDI guide to ask respondents about their perception and experiences with CVD, particularly regarding causation and preventability. We manually applied qualitative content analysis to evaluate the data and grouped similar content into categories and subcategories.

RESULTS

Respondents perceived dietary factors, particularly consumption of salty, fatty, and oily food, as the main determinants of CVD. Similarly, our respondents unanimously linked smoking, alcohol intake, and high blood pressure with cardiac ailments but reported mixed opinion regarding the causal role of body weight and physical inactivity. Although depressed and stressed at the time of diagnosis, respondents learned to handle their situation better over time. Despite good family support for health care, the financial burden of disease was a major issue. All respondents understood the importance of lifestyle modification and relied upon health professionals for information and motivation. Respondents remarked that community awareness of CVD was inadequate and that medical doctors or trained local people should help increase awareness.

CONCLUSIONS

This study provided insight into the perceptions of patients regarding CVD. Respondents embraced the importance of lifestyle modification only after receiving their diagnosis. Although better health care is important in terms of aiding patients to better understand and cope with their disease, interventions should be tailored to improve the community's cardiovascular health literacy and preventive practices.

Gestational diabetes and hypertensive disorders of pregnancy as vascular risk signals: an overview and grading of the evidence

The occurrence of common pregnancy-related medical disorders identifies women at high risk of developing future vascular disease. Systematic reviews of cohort studies demonstrate that gestational diabetes confers a 7-fold risk increase for type 2 diabetes, and preeclampsia confers a 1.8-fold risk increase for type 2 diabetes and 3.4-fold risk increase for hypertension. Gestational diabetes and hypertensive disorders of pregnancy (HDP) increase the risk of premature vascular disease, but the 2-fold risk increase associated with preeclampsia is only partially explained by the development of traditional vascular risk factors. Despite the compelling evidence for gestational diabetes and HDP as vascular risk indicators, there are no published Canadian vascular prevention guidelines that recognize these postpartum women. In contrast, the 2011 American Heart Association guidelines on cardiovascular disease in women include gestational diabetes and HDP in their vascular risk assessment. Studies indicate that the importance surveillance of vascular risk factors in these women after pregnancy is underappreciated by the women themselves and their physicians. Although a prudent diet and physically active lifestyle were demonstrated to reduce diabetes risk in women with a gestational diabetes history in the American Diabetes Prevention Program trial, adoption of these health behaviours is low; qualitative studies confirm a need for tailored strategies that address barriers and provide social support. Further research is also needed on approaches to reduce vascular risk in women with a history of gestational diabetes and HDP. Otherwise, an early window of opportunity for chronic disease prevention in young, high-risk women will be missed.

Postpartum care for Aboriginal and non-Aboriginal women with Gestational Diabetes Mellitus across urban, rural and remote locations: a protocol for a cohort linkage study

BACKGROUND

Gestational diabetes mellitus (GDM) is increasing, along with obesity and type 2 diabetes (T2DM), with Aboriginal and Torres Strait Islander (Aboriginal(a)) women in Australia particularly affected. GDM causes serious complications in pregnancy, birth, and the longer term, for women and their infants. Women with GDM have an eightfold risk of developing T2DM after pregnancy, compared to women without GDM. Indigenous women have an even higher risk, at a younger age, and progress more quickly from GDM to T2DM, compared to non-Indigenous women. If left undetected and untreated, T2DM increases risks in subsequent pregnancies, and can lead to heart disease, stroke, kidney failure, limb amputations and blindness for the woman in the longer term. A GDM diagnosis offers a 'window of opportunity' to provide acceptable and effective prevention, treatment, and postpartum care. Low rates of postpartum T2DM screening are reported among non-Aboriginal women in Australia and Indigenous women in other countries, however, data for Aboriginal women in Australia are scarce. A healthy diet, exercise and breastfeeding can delay the onset of T2DM, and together with T2DM screening are recommended elements of postpartum care for women with GDM. This paper describes methods for a study evaluating postpartum care among Aboriginal and non-Aboriginal women with GDM.

METHODS/DESIGN

This retrospective cohort includes all women who gave birth at Cairns Hospital in far north Queensland, Australia, from 2004 to 2010, coded as having GDM in the Cairns Hospital Clinical Coding system. Data is being linked with the Midwives Perinatal Data Collection, and the three local laboratories. Hospital medical records are being reviewed to validate accuracy of GDM case ascertainment, and gather information on breastfeeding and provision of dietary advice. Survival analysis is being used to estimate time to screening, and rates of progression from GDM to T2DM. Logistic regression is being used to compare postpartum care between Aboriginal and non-Aboriginal women, and assess factors that may be associated with provision of postpartum care.

DISCUSSION

There are challenges to collecting postpartum data for women with GDM, however, this research is urgently needed to ensure adequate postpartum care is provided for women with GDM.

Strategies to optimize participation in diabetes prevention programs following gestational diabetes: a focus group study

OBJECTIVE

We performed a qualitative study among women within 5 years of Gestational Diabetes (GDM) diagnosis. Our aim was to identify the key elements that would enhance participation in a type 2 diabetes (DM2) prevention program.

RESEARCH DESIGN AND METHODS

Potential participants received up to three invitation letters from their GDM physician. Four focus groups were held. Discussants were invited to comment on potential facilitators/barriers to participation and were probed on attitudes towards meal replacement and Internet/social media tools. Recurring themes were identified through qualitative content analysis of discussion transcripts.

RESULTS

Among the 1,201 contacted and 79 eligible/interested, 29 women attended a focus group discussion. More than half of discussants were overweight/obese, and less than half were physically active. For DM2 prevention, a strong need for social support to achieve changes in dietary and physical activity habits was expressed. In this regard, face-to-face interactions with peers and professionals were preferred, with adjunctive roles for Internet/social media. Further, direct participation of partners/spouses in a DM2 prevention program was viewed as important to enhance support for behavioural change at home. Discussants highlighted work and child-related responsibilities as potential barriers to participation, and emphasized the importance of childcare support to allow attendance. Meal replacements were viewed with little interest, with concerns that their use would provide a poor example of eating behaviour to children.

CONCLUSIONS

Among women within 5 years of a GDM diagnosis who participated in a focus group discussion, participation in a DM2 prevention program would be enhanced by face-to-face interactions with professionals and peers, provision of childcare support, and inclusion of spouses/partners.

Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States

Recently proposed international guidelines for screening for gestational diabetes mellitus (GDM) recommend additional screening in early pregnancy for sub-populations at a high risk of type 2 diabetes mellitus (T2DM), such as indigenous women. However, there are criteria that should be met to ensure the benefits outweigh the risks of population-based screening. This review examines the published evidence for early screening for indigenous women as related to these criteria. Any publications were included that referred to diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States (n = 145). The risk of bias was appraised. There is sufficient evidence describing the epidemiology of diabetes in pregnancy, demonstrating that it imposes a significant disease burden on indigenous women and their infants at birth and across the lifecourse (n = 120 studies). Women with pre-existing T2DM have a higher risk than women who develop GDM during pregnancy. However, there was insufficient evidence to address the remaining five criteria, including the following: understanding current screening practice and rates (n = 7); acceptability of GDM screening (n = 0); efficacy and cost of screening for GDM (n = 3); availability of effective treatment after diagnosis (n = 6); and effective systems for follow-up after pregnancy (n = 5). Given the impact of diabetes in pregnancy, particularly undiagnosed T2DM, GDM screening in early pregnancy offers potential benefits for indigenous women. However, researchers, policy makers and clinicians must work together with communities to develop effective strategies for implementation and minimizing the potential risks. Evidence of effective strategies for primary prevention, GDM treatment and follow-up after pregnancy are urgently needed.