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Marschner S, Cheung NW, Wing‐Lun E, Kazi S, Trivedi R, Chow CK. Primary care management post gestational diabetes in Australia. Intern Med J 2024; 54:164-171. [PMID: 37151178 PMCID: PMC10952553 DOI: 10.1111/imj.16106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/03/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Women with a history of gestational diabetes (GD) have a high risk of developing diabetes and subsequent cardiovascular disease (CVD). AIM To assess whether diabetes screening and CVD risk screening occurred in general practice (GP) among postpartum women with GD. METHODS This is a retrospective study of clinical record data of women with GD, under active GP management, from the MedicineInsight programme, run by Australia's National Prescribing Service MedicineWise, with GP sites located in Australia from January 2015 to March 2021. Documentation of screening for diabetes, assessment of lipids and measurement of blood pressure (BP) was assessed using proportions and mixed-effects logistic regression with a log follow-up time offset. RESULTS There were 10 413 women, with a mean age of 37.9 years (standard deviation, 7.6), from 406 clinics with a mean follow-up of 4.6 years (interquartile range, 1.8-6.2 years) A total of 29.41% (3062/10 413; 95% confidence interval [CI], 28.53-30.28) had not been assessed for diabetes, 37.40% (3894/10 413; 95% CI, 36.47-38.32) were not assessed for lipids and 2.19% (228/10 413; 95% CI, 1.91-2.47) had no BP documented. In total, 51.82% (5396/10 413; 95% CI, 50.86-52.78) were screened for all three (diabetes + lipids + BP) at least once. Obesity, comorbidities and dyslipidaemia were associated with increased likelihood of screening. New diabetes diagnosis was documented in 5.73% (597/10 413; 95% CI, 5.29-6.18) of the cohort. CONCLUSION Screening for diabetes and hyperlipidaemia was suboptimal in this high-risk cohort of women with prior GD. Improved messaging that women with a GD diagnosis are at high cardiovascular risk may improve subsequent screening.
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Affiliation(s)
- Simone Marschner
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
| | - N. Wah Cheung
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
- Department of Diabetes & EndocrinologyWestmead HospitalSydneyNew South WalesAustralia
| | - Edwina Wing‐Lun
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
- Royal Darwin Hospital, Menzies School of Health ResearchUniversity of SydneySydneyNew South WalesAustralia
| | - Samia Kazi
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
| | - Ritu Trivedi
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
| | - Clara K. Chow
- Westmead Applied Research CentreThe University of SydneySydneyNew South WalesAustralia
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
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Melov SJ, Elhindi J, White L, McNab J, Lee VW, Donnolley K, Alahakoon TI, Padmanabhan S, Cheung NW, Pasupathy D. Previous High-Intensity Breastfeeding Lowers the Risk of an Abnormal Fasting Glucose in a Subsequent Pregnancy Oral Glucose Tolerance Test. Nutrients 2023; 16:28. [PMID: 38201858 PMCID: PMC10780944 DOI: 10.3390/nu16010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Breastfeeding is associated with reduced lifetime cardiometabolic risk, but little is known regarding the metabolic benefit in a subsequent pregnancy. The primary aim of this study was to investigate the association between breastfeeding duration and intensity and next pregnancy oral glucose tolerance test (OGTT) results. A retrospective cohort study was conducted from March 2020 to October 2022. All multiparous women who met inclusion criteria and gave birth during the study period were eligible for inclusion. Analysis was stratified by risk for gestational diabetes (GDM). High GDM risk criteria included previous GDM and BMI > 35 kg/m2. The association between breastfeeding duration and high-intensity breastfeeding (HIBF) and subsequent pregnancy OGTT were assessed with multivariate logistic models adjusted for statistically and clinically relevant covariables. There were 5374 multiparous participants who met the inclusion criteria for analysis. Of these, 61.7% had previously breastfed for >6 months, and 43.4% were at high risk for GDM. HIBF was associated with 47% reduced odds of an abnormal fasting glucose in a subsequent pregnancy OGTT (aOR 0.53; 95%CI 0.38-0.75; p < 0.01). There was no association between HIBF and other glucose results on the OGTT. Women who smoked were least likely to breastfeed at high intensity (aOR 0.31; 95%CI 0.21-0.47; p < 0.01). South Asian women had 65% higher odds of HIBF than women who identified as White/European (aOR 1.65; 1.36-2.00; p < 0.01). This study highlights the importance of exclusive breastfeeding to potentially reduce the prevalence of GDM and may also translate into long-term reduction of cardiometabolic risk.
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Affiliation(s)
- Sarah J. Melov
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (J.E.); (J.M.); (D.P.)
- Westmead Institute for Maternal and Fetal Medicine, Women’s and Newborn Health, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia;
| | - James Elhindi
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (J.E.); (J.M.); (D.P.)
| | - Lisa White
- Women’s Health Maternity, Blacktown and Mt Druitt Hospitals, Blacktown, NSW 2148, Australia;
| | - Justin McNab
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (J.E.); (J.M.); (D.P.)
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (V.W.L.); (N.W.C.)
| | - Vincent W. Lee
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (V.W.L.); (N.W.C.)
- Department of Renal Medicine, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia
| | - Kelly Donnolley
- Consumer Representative, Western Sydney Local Health District, Sydney, NSW 2151, Australia
| | - Thushari I. Alahakoon
- Westmead Institute for Maternal and Fetal Medicine, Women’s and Newborn Health, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia;
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (V.W.L.); (N.W.C.)
| | - Suja Padmanabhan
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia;
| | - N. Wah Cheung
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (V.W.L.); (N.W.C.)
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia;
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (J.E.); (J.M.); (D.P.)
- Westmead Institute for Maternal and Fetal Medicine, Women’s and Newborn Health, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia;
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Roesler A, Butten K, Calyx C, Holmes-Truscott E, Taylor P. Use and Preferences of Health Apps among Women and Healthcare Professionals Regarding GDM Postpartum Care Related to Diet, Physical Activity, and Weight Management: A Cross-Sectional Survey. Nutrients 2023; 15:3304. [PMID: 37571242 PMCID: PMC10420904 DOI: 10.3390/nu15153304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Gestational Diabetes Mellitus (GDM) is a common medical complication of pregnancy, which is associated with increased risk of future diabetes. mHealth (mobile health, in this paper applications abbreviated to apps) can facilitate health modifications to decrease future risks. This study aims to understand mHealth app use and preferences among women with past GDM and healthcare professionals (HCP) in Australia. An explorative cross-sectional online survey was disseminated via social media, a national diabetes registry, and professional networks. Descriptive analyses were conducted on valid responses (women with prior GDM: n = 1475; HCP: n = 75). One third (33%) of women with prior GDM have used health apps, and a further 80% of non-app users were open to using a health app if recommended by their HCP. Over half (53%) of HCPs supported health information delivery via mHealth, although only 14% had recommended a health app to women post-GDM, and lack of knowledge about mHealth apps was common. Health app users reported that they preferred tracking features, while non-users desired credible health and dietary information and plans. Expanding mHealth app use could facilitate healthy behaviours, but endorsement by HCPs is important to women and is still currently lacking.
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Affiliation(s)
- Anna Roesler
- The Australian e-Health Research Centre, CSIRO, Herston, QLD 4006, Australia; (K.B.); (P.T.)
| | - Kaley Butten
- The Australian e-Health Research Centre, CSIRO, Herston, QLD 4006, Australia; (K.B.); (P.T.)
| | - Cobi Calyx
- School of Humanities and Languages, UNSW Sydney, Sydney, NSW 1466, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Institute for Health Transformation, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia;
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 15-31 Pelham Street, Carlton, VIC 3053, Australia
| | - Pennie Taylor
- The Australian e-Health Research Centre, CSIRO, Herston, QLD 4006, Australia; (K.B.); (P.T.)
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Marschner S, Pant A, Henry A, Maple‐Brown LJ, Moran L, Cheung NW, Chow CK, Zaman S. Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review. Med J Aust 2023; 218:484-491. [PMID: 37149790 PMCID: PMC10953444 DOI: 10.5694/mja2.51932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Affiliation(s)
| | - Anushriya Pant
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
| | - Amanda Henry
- University of New South WalesSydneyNSW
- St George HospitalSydneyNSW
| | - Louise J Maple‐Brown
- Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health ResearchDarwinNT
- Royal Darwin HospitalDarwinNT
| | - Lisa Moran
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
- Monash HealthMelbourneVIC
| | - N Wah Cheung
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Clara K Chow
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Sarah Zaman
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
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Cheung NW, Thiagalingam A, Smith BJ, Redfern J, Barry T, Mercorelli L, Chow CK. Text messages promoting healthy lifestyle and linked with activity monitors stimulate an immediate increase in physical activity among women after gestational diabetes. Diabetes Res Clin Pract 2022; 190:109991. [PMID: 35835256 DOI: 10.1016/j.diabres.2022.109991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/13/2022] [Accepted: 07/08/2022] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the immediate effect of text messages promoting healthy lifestyle and supporting parenting on physical activity amongst women with recent gestational diabetes (GDM). METHODS Analysis of data from a pilot randomised controlled trial of a healthy lifestyle program for women with recent GDM. Intervention subjects received text messages providing motivation, reminders, information and feedback as well as an activity monitor. This sub-study examined step count in the 4 h after receipt of a text message, compared to the same time of day on other days among intervention subjects. RESULTS Data from 7326 days where step counts were recorded, from 31 women were analysed. The median steps in the 4 h following a text message was 1237 (IQR 18-2240) and it was 1063 (IQR 0-2038) over the same time period on comparison days where there was no message (p < 0.001). The effect was similar whether the messages pertained to physical activity or not. There was no attenuation of the response over 36-38 weeks. CONCLUSIONS Women with recent GDM increase their step count in the hours following positive and supportive text messages. This suggests that text messaging programs can facilitate healthy lifestyle and diabetes prevention in this population.
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Affiliation(s)
- N Wah Cheung
- Department of Diabetes & Endocrinology, Westmead Hospital, Westmead, NSW 2145, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
| | - Ben J Smith
- School of Public Health, University of Sydney, NSW 2006, Australia.
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
| | - Tony Barry
- Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
| | - Louis Mercorelli
- Sydney Informatics Hub, University of Sydney, Darlington, NSW 2008, Australia.
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia; Department of Cardiology, Westmead Hospital, Westmead, NSW 2145, Australia.
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