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Milluzzo A, Manuella L, Frittitta L, Sciacca L. Efficacy of a phone reminder to improve adherence to post-partum glucose tolerance testing after gestational diabetes and clinical predictors of post-partum follow-up compliance. Diabetes Res Clin Pract 2024; 210:111653. [PMID: 38574892 DOI: 10.1016/j.diabres.2024.111653] [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: 01/28/2024] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
AIM To assess the effectiveness of a phone reminder to improve adherence to post-partum glucose tolerance testing in women with gestational diabetes mellitus (GDM) and to identify clinical predictors of adherence to post-partum follow-up. METHODS Retrospective study including 543 women with GDM. We assessed the adherence rate to post-partum glucose tolerance testing in women who received a phone reminder (n = 297) compared to women not alerted (n = 246). Demographic and clinical variables were collected to identify the predictors of adherence to the post-partum oral glucose tolerance test (OGTT). RESULTS The adherence to post-partum OGTT was higher in women who received the phone reminder compared to those not alerted (60.6 % vs. 35.4 %, p < 0.001). Women less compliant compared to those more compliant, had a higher pre-pregnancy body mass index (BMI) (29.3 ± 7.9 vs. 27.0 ± 6.1 Kg/m2, p = 0.03). The adherence was lower in pre-pregnant obese compared to non-obese women (42.7 % vs. 52.0 %, p < 0.05), in women with only one, compared to multiple OGTT alterations during pregnancy (44.5 % vs. 57.8 %, p < 0.05), and in women non-insulin treated compared to those insulin-treated (40.0 % vs. 57.1 % vs, p < 0.001). CONCLUSIONS The phone reminder improved post-partum follow-up adherence. Pre-pregnancy BMI, number of OGTT alterations and type of therapy could identify poorly adherent women.
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Affiliation(s)
- Agostino Milluzzo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Diabetes and Obesity Center, Garibaldi-Nesima Hospital, Catania, Italy.
| | - Lucia Manuella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lucia Frittitta
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Diabetes and Obesity Center, Garibaldi-Nesima Hospital, Catania, Italy
| | - Laura Sciacca
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Endocrinology, Garibaldi-Nesima Hospital, Catania, Italy
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2
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Daly BM, Wu Z, Nirantharakumar K, Chepulis L, Rowan JA, Scragg RKR. Increased risk of cardiovascular and renal disease, and diabetes for all women diagnosed with gestational diabetes mellitus in New Zealand-A national retrospective cohort study. J Diabetes 2024; 16:e13535. [PMID: 38599878 PMCID: PMC11006618 DOI: 10.1111/1753-0407.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus increases the risk of developing type 2 diabetes. The aim of this study is to compare cardiometabolic and renal outcomes for all women in New Zealand with gestational diabetes (2001-2010) with women without diabetes, 10-20 years following delivery. METHODS A retrospective cohort study, utilizing a national dataset providing information for all women who gave birth between 1 January 2001 and 31 December 2010 (n = 604 398). Adolescent girls <15 years, women ≥50 years and women with prepregnancy diabetes were excluded. In total 11 459 women were diagnosed with gestational diabetes and 11 447 were matched (for age and year of delivery) with 57 235 unexposed (control) women. A national hospital dataset was used to compare primary outcomes until 31 May 2021. RESULTS After controlling for ethnicity, women with gestational diabetes were significantly more likely than control women to develop diabetes-adjusted hazard ratio (HR) 20.06 and 95% confidence interval (CI) 18.46-21.79; a first cardiovascular event 2.19 (1.86-2.58); renal disease 6.34 (5.35-7.51) and all-cause mortality 1.55 (1.31-1.83), all p values <.0001. The HR and 95% CI remained similar after controlling for significant covariates: diabetes 18.89 (17.36-20.56), cardiovascular events 1.79 (1.52-2.12), renal disease 5.42 (4.55-6.45), and all-cause mortality 1.44 (1.21-1.70). When time-dependent diabetes was added to the model, significance remained for cardiovascular events 1.33 (1.10-1.61), p = .003 and renal disease 2.33 (1.88-2.88), p < .0001 but not all-cause mortality. CONCLUSIONS Women diagnosed with gestational diabetes have an increased risk of adverse cardiometabolic and renal outcomes. Findings highlight the importance of follow-up screening for diabetes, cardiovascular risk factors, and renal disease.
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Affiliation(s)
- Barbara M. Daly
- Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Zhenqiang Wu
- Department of Geriatric MedicineUniversity of AucklandAucklandNew Zealand
| | - Krishnarajah Nirantharakumar
- Professor in Health Data Science and Public Health, Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Lynne Chepulis
- School of HealthUniversity of WaikatoHamiltonWaikatoNew Zealand
| | - Janet A. Rowan
- National Women Health at Auckland City HospitalAucklandNew Zealand
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Arntzen E, Jøsendal R, Sandsæter HL, Horn J. Postpartum follow-up of women with preeclampsia: facilitators and barriers - A qualitative study. BMC Pregnancy Childbirth 2023; 23:833. [PMID: 38049716 PMCID: PMC10694896 DOI: 10.1186/s12884-023-06146-8] [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: 07/25/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Pregnancy causes physiological changes to the maternal organ systems that can be regarded as a cardiometabolic stress test for women. Preeclampsia, a pregnancy complication characterized by new onset of hypertension in combination with proteinuria or end-organ dysfunction, affects approximately 2-8% of pregnancies. Adverse pregnancy outcomes, including preeclampsia, have been described as a failed stress test and have been consistently linked with increased risk of cardiovascular disease later in life. The postpartum period is therefore often regarded as a window of opportunity for cardiovascular disease prevention. However, we lack knowledge about how women with preeclampsia experience current postpartum care in the Norwegian health system. The aim of this qualitative study is to uncover women's perspectives and preferences regarding postpartum follow-up. METHODS Semi-structured telephone interviews were conducted with 17 women following a six-month lifestyle intervention study. Participants were 9-20 months postpartum, following a pregnancy complicated by preeclampsia. Data were analyzed using Malterud's systematic text condensation. RESULTS We identified five themes, each with 2-3 subthemes, that demonstrate how women with recent preeclampsia experience postpartum follow-up: (1) fear and uncertainty (a body out of balance and facing an uncertain future), (2) a conversation on lifestyle - not really that difficult (preeclampsia as a gateway, a respectful approach, and a desire for more constructive feedback), (3) when your own health is not a priority (a new everyday life, out of focus, and lack of support), (4) motivation for lifestyle changes (an eye opener, lack of intrinsic motivation, and a helping hand), and (5) lack of structured and organized follow-up (there should be a proper system, a one-sided follow-up care, and individual variation in follow-up care). CONCLUSIONS Findings from this study highlight the need for more systematic postpartum follow-up for women after a pregnancy complicated by preeclampsia. Further research is required to explore the potential use of standardized guidelines and routine invitations to postpartum care. Furthermore, exploring health care professionals' experiences is crucial to ensure their engagement in postpartum care after complicated pregnancies.
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Affiliation(s)
- Eirin Arntzen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway
| | - Ranveig Jøsendal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway
| | - Heidi Linn Sandsæter
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Julie Horn
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway.
- Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
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Huang J, Forde R, Parsons J, Zhao X, Wang J, Liu Y, Forbes A. Interventions to increase the uptake of postpartum diabetes screening among women with previous gestational diabetes: a systematic review and Bayesian network meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101137. [PMID: 37619781 DOI: 10.1016/j.ajogmf.2023.101137] [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: 06/16/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE This study aimed to summarize the current interventions aimed at improving postpartum diabetes screening attendance and to compare their effectiveness. DATA SOURCES Literature searches were conducted in the Web of Science, Embase, Cochrane Library, CINAHL, and PubMed from inception to March 20, 2023. STUDY ELIGIBILITY CRITERIA Quantitative studies involving an intervention to increase postpartum diabetes screening attendance among women with gestational diabetes mellitus were included. METHODS The Joanna Briggs Institute checklists were used for the quality appraisal of the included studies. A Bayesian network meta-analysis was performed to synthesize the comparative effectiveness of the relevant interventions aimed at improving postpartum diabetes screening rates. RESULTS A total of 40 studies were included in this review with pooled data from 17,123 women. Studies included randomized controlled trials (n=11, including 3 US-based studies and 8 non-US-based studies) and nonrandomised studies (n=29, including 13 US-based studies and 16 non-US-based studies). Of the 14 studies that reported screening outcomes, 11 detected early type 2 diabetes at a rate ranging from 2.0% to 23.0%. The types of interventions identified included reminders (eg, postal letters, emails, and phone messages), educational interventions, screening methods and delivery, policy changes, antenatal groups, and multimodal interventions. Based on the network meta-analysis from randomized controlled trials, antenatal group intervention, which refers to antenatal patient education delivered in groups (1 US-based study), had the highest probability to be the most effective intervention (odds ratio, 10; 95% confidence interval, 1.6-77.0), followed by one-to-one educational intervention with written educational materials or counselling (odds ratio, 6.9; 95% confidence interval, 3.6-16.0). The results from nonrandomized studies indicated that flexible screening methods and delivery (2 US-based studies) had the greatest impact on screening uptake (odds ratio, 3.9; 95% confidence interval, 1.8-10.0), followed by educational interventions (1 US-based study and 2 non-US-based studies) with antenatal patient education and written educational materials (odds ratio, 3.4; 95% confidence interval, 1.9-6.3) and antenatal groups (odds ratio, 3.3; 95% confidence interval, 1.7-6.7). CONCLUSION The presented evidence suggests that antenatal patient education delivered in groups and offering more flexible screening methods were associated with the greatest increase in attendance. The multimodal interventions and reminders could still be important if they were more theoretically grounded and were more integrated into the healthcare system.
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Affiliation(s)
- Jing Huang
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes).
| | - Rita Forde
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Judith Parsons
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Xiaoyan Zhao
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Jianying Wang
- Labour room, Northwest Women's and Children's Hospital, Xi'an, China (Mses Wang and Liu)
| | - Yingjie Liu
- Labour room, Northwest Women's and Children's Hospital, Xi'an, China (Mses Wang and Liu)
| | - Angus Forbes
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
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Cronin Á, Noctor E, O' Doherty D, Bowers S, Byrne E, Cremona A. Facilitators and barriers to attending postpartum screening in women with a recent pregnancy complicated by gestational diabetes mellitus: a qualitative study. Public Health 2023; 220:99-107. [PMID: 37290175 DOI: 10.1016/j.puhe.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Pregnant women with gestational diabetes mellitus (GDM) are 50% more likely to develop type II diabetes (T2D) within 6 months to 2 years after giving birth. Therefore, international guidelines recommend it is best practice for women diagnosed with GDM to attend screening for T2D 6-12 weeks postpartum and every 1-3 years thereafter for life. However, uptake of postpartum screening is suboptimal. This study will explore the facilitators of and barriers to attending postpartum screening for T2D that women experience. STUDY DESIGN This was a prospective qualitative cohort study using thematic analysis. METHODS A total of 27 in-depth, semistructured interviews were conducted over the telephone with women who had recent GDM. Interviews were recorded and transcribed, and data were analysed using thematic analysis. RESULTS Facilitators of and barriers to attending postpartum screening were identified at three different levels: personal, intervention, and healthcare systems level. The most common facilitators identified were concern for their own health and having the importance of screening explained to them by a health professional. The most common barriers identified were confusion over the test and COVID-19. CONCLUSION This study identified several facilitators of and barriers to attending postpartum screening. These findings will help to inform research and interventions for improving rates of attendance at postpartum screening to reduce the subsequent risk of developing T2D.
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Affiliation(s)
- Á Cronin
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - E Noctor
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Ireland; Division of Endocrinology, UL Hospital Group, Limerick, Ireland; Health Science Academy, University Hospital Limerick, Limerick, Ireland
| | - D O' Doherty
- School of Medicine, University of Limerick, Ireland
| | - S Bowers
- Department of Clinical Nutrition and Dietetics, UL Hospital Group, Limerick, Ireland; Health Science Academy, University Hospital Limerick, Limerick, Ireland
| | - E Byrne
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - A Cremona
- Discipline of Dietetics, School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Health Science Academy, University Hospital Limerick, Limerick, Ireland.
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6
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Lake AJ, Williams A, Neven ACH, Boyle JA, Dunbar JA, Hendrieckx C, Morrison M, O’Reilly SL, Teede H, Speight J. Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A qualitative study applying the Theoretical Domains Framework. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1086186. [PMID: 36993822 PMCID: PMC10012118 DOI: 10.3389/fcdhc.2023.1086186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/12/2023] [Indexed: 03/02/2023]
Abstract
IntroductionWomen with previous gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2D). Guidelines recommend postnatal diabetes screening (oral glucose tolerance test or HbA1c) typically 6-12 weeks after birth, with screening maintained at regular intervals thereafter. Despite this, around half of women are not screened, representing a critical missed opportunity for early identification of prediabetes or type 2 diabetes. While policy and practice-level recommendations are comprehensive, those at the personal-level primarily focus on increasing screening knowledge and risk perception, potentially missing other influential behavioral determinants. We aimed to identify modifiable, personal-level factors impacting postpartum type 2 diabetes screening among Australian women with prior gestational diabetes and recommend intervention functions and behavior change techniques to underpin intervention content.Research design and methodsSemi-structured interviews with participants recruited via Australia’s National Gestational Diabetes Register, using a guide based on the Theoretical Domains Framework (TDF). Using an inductive-deductive approach, we coded data to TDF domains. We used established criteria to identify ‘important’ domains which we then mapped to the Capability, Opportunity, Motivation–Behavior (COM-B) model.ResultsNineteen women participated: 34 ± 4 years, 19 ± 4 months postpartum, 63% Australian-born, 90% metropolitan, 58% screened for T2D according to guidelines. Eight TDF domains were identified: ‘knowledge’, ‘memory, attention, and decision-making processes’, ‘environmental context and resources’, ‘social influences’, ‘emotion’, ‘beliefs about consequences’, ‘social role and identity’, and ‘beliefs about capabilities’. Study strengths include a methodologically rigorous design; limitations include low recruitment and homogenous sample.ConclusionsThis study identified numerous modifiable barriers and enablers to postpartum T2D screening for women with prior GDM. By mapping to the COM-B, we identified intervention functions and behavior change techniques to underpin intervention content. These findings provide a valuable evidence base for developing messaging and interventions that target the behavioral determinants most likely to optimize T2D screening uptake among women with prior GDM.
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Affiliation(s)
- Amelia J. Lake
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- *Correspondence: Amelia J. Lake,
| | - Amelia Williams
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Adriana C. H. Neven
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
- Monash Department of Obstetrics and Gynecology, Monash Health, Clayton, VIC, Australia
| | - James A. Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, VIC, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | | | - Sharleen L. O’Reilly
- School of Exercise & Nutrition Science, Deakin University, Burwood, VIC, Australia
- UCD Institute of Food and Health, College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
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7
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Nielsen JH, Fonager K, Kristensen JK, Overgaard C. Effect of an electronic reminder of follow-up screening after pregnancy complicated by gestational diabetes mellitus: a randomized controlled trial. BMC Public Health 2023; 23:153. [PMID: 36690965 PMCID: PMC9872380 DOI: 10.1186/s12889-023-15060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
AIM To determine the effectiveness of despatching an electronic reminder of participation in screening for gestational diabetes. The reminder was sent to the women 1-8 years after delivery. METHODS A registry-based, randomized controlled trial in the North Denmark Region among women with gestational diabetes. Randomization was made, which included seven groups stratified by the child's birth year (2012-2018). The intervention group received standard care supplemented by an electronic reminder through a secure nationwide email system (n = 731), while the control group received only standard care (n = 732). The primary outcome was based on blood testing for diabetes (OGTT, HbA1c or fasting P-glucose). RESULTS A total of 471 (32.1%) women participated in screening. The primary outcome was experienced by 257 women (35.1%) in the intervention group and 214 women (29.2%) in the control group. The effect of the reminder seemed to increase with recipient's age, non-western origin, urban dwelling, and multiparity. Of those who participated in follow-up screening, 56 (3.8%) were diagnosed with type 2 diabetes. CONCLUSION Electronic reminders, based on the principles of informed choice and patient-centred care, to women have been shown to support life-long participation in follow-up screening. Attempts to further stimulation of coverage could however be considered. TRAIL REGISTRATION ISRCTN registry (22/04/2022, ISRCTN23558707).
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Affiliation(s)
- Jane Hyldgaard Nielsen
- Department of Midwifery, University College of Northern Denmark, Aalborg Øst, Denmark.
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
- Research Center for Health and Applied Technology, University College of Northern Denmark, Aalborg, Denmark.
- DECIPH'er, Cardiff School of Social Sciences, Cardiff University, Cardiff, Wales.
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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8
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Adam S, McIntyre HD, Tsoi KY, Kapur A, Ma RC, Dias S, Okong P, Hod M, Poon LC, Smith GN, Bergman L, Algurjia E, O'Brien P, Medina VP, Maxwell CV, Regan L, Rosser ML, Jacobsson B, Hanson MA, O'Reilly SL, McAuliffe FM. Pregnancy as an opportunity to prevent type 2 diabetes mellitus: FIGO Best Practice Advice. Int J Gynaecol Obstet 2023; 160 Suppl 1:56-67. [PMID: 36635082 PMCID: PMC10107137 DOI: 10.1002/ijgo.14537] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8-10-fold higher risk of developing type 2 diabetes and a 2-fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.
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Affiliation(s)
- Sumaiya Adam
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Harold David McIntyre
- Mater Health, University of Queensland, Mater Health Campus, South Brisbane, Queensland, Australia
| | - Kit Ying Tsoi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China
| | - Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Cape Town, South Africa
| | - Pius Okong
- Department of Obstetrics and Gynecology, St Francis Hospital Nsambya, Kampala City, Uganda
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Esraa Algurjia
- The World Association of Trainees in Obstetrics and Gynecology (WATOG), Paris, France.,Elwya Maternity Hospital, Baghdad, Iraq
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Virna P Medina
- Department of Obstetrics and Gynecology, Faculty of Health, Universidad del Valle, Clínica Imbanaco Quirón Salud, Universidad Libre, Cali, Colombia
| | - Cynthia V Maxwell
- Maternal Fetal Medicine, Sinai Health and Women's College Hospital University of Toronto, Ontario, Canada
| | | | - Mary L Rosser
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
| | - Mark A Hanson
- Institute of Developmental Sciences, University Hospital Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Sharleen L O'Reilly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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9
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Nedergaard JB, Nielsen JH, Andersen LMB, Dahl TA, Overgaard C. A kind reminder-A qualitative process evaluation of women's perspectives on receiving a reminder of type 2 diabetes follow-up screening after gestational diabetes. J Eval Clin Pract 2022; 29:591-601. [PMID: 36585792 DOI: 10.1111/jep.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Women with previous gestational diabetes mellitus (GDM) are more than eight times more likely to develop type 2 diabetes (T2DM) compared to women without GDM. Annual follow-up T2DM-screening is recommended, but participation rates decrease rapidly after the first year. In the North Denmark Region, an electronic reminder has been tested with the aim of improving follow-up care for women with prior GDM. The aim of this study was to explore women's perspectives on receiving an electronic reminder, and the role of reminders in both women's decision-making and informed choice regarding participation in follow-up screening. METHODS A qualitative process evaluation informed by a critical realistic perspective. Data consisted of 20 semi-structured interviews with women previously diagnosed with GDM who had received the reminder. Interviews were analyzed using reflexive thematic analysis. RESULTS The reminder affected women's decision-making and informed choices through a range of mechanisms. Its personalized design prompted feelings of co-responsibility and care from the healthcare system, supported continuity in women's care pathways, and helped women bridge the gap between healthcare sectors. Women's perception of diabetes risk and the importance of follow-up influenced their decision-making. Participation in follow-up screening was influenced by several contextual factors, as women's everyday life impeded their prioritizing follow-up screening. Women who experienced being met by their general practitioner (GP) with acknowledgement rather than stigmatization and received supportive information tailored to their life situation were more motivated to participate in future follow-up screenings. CONCLUSION The reminder indicated both concern and co-responsibility for women's follow-up care after GDM and was well received by the women. It supported participation in follow-up screening through an emphasis on shared decision-making and informed choice. Women's interaction with their GP played a significant role.
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Affiliation(s)
- Julie B Nedergaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jane H Nielsen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark.,Research Center for Health and Applied Technology, University College of Northern Denmark, Aalborg, Denmark
| | - Laerke M B Andersen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Tina A Dahl
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Department of Public Health, University of Southern Denmark, Odense, Denmark
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Society for Maternal-Fetal Medicine Special Statement: Quality metric on the rate of postpartum diabetes screening after pregnancies with gestational diabetes mellitus. Am J Obstet Gynecol 2022; 228:B2-B9. [PMID: 36584961 DOI: 10.1016/j.ajog.2022.12.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As many as 1 in 3 patients with gestational diabetes mellitus have impaired glucose metabolism when screened postpartum. These patients have a 40% to 70% lifetime risk of progression to type 2 diabetes mellitus, but progression can be delayed or prevented by lifestyle interventions or medication. The American College of Obstetricians and Gynecologists and the American Diabetes Association recommend a glucose tolerance test at 4 to 12 weeks postpartum for all patients with gestational diabetes mellitus. Despite these recommendations, postpartum screening rates are typically <50%, representing a major healthcare "quality gap." The Society for Maternal-Fetal Medicine proposes a uniform metric that identifies the percentage of persons with gestational diabetes mellitus who completed a 75-g, 2-hour glucose tolerance test within 12 weeks after delivery. The metric is designed to be measured using diagnosis and procedure codes in payor claims data. Barriers to screening are discussed. Possible uses of the metric for quality improvement projects are outlined. Increasing the rate of postpartum diabetes screening should facilitate timely referral to implement lifestyle modifications, medication, and long-term follow-up. Use of the metric in financial incentive programs is discouraged at this time.
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Follow-up after gestational diabetes: a qualitative study of perspectives from general practices. BJGP Open 2022; 6:BJGPO.2021.0241. [PMID: 35443978 DOI: 10.3399/bjgpo.2021.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/25/2022] [Accepted: 04/05/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Women whose pregnancies are complicated by gestational diabetes mellitus are approximately eight times more likely to develop type two diabetes. Although regular participation in follow-up screening increases the chance of early detection of diabetes, participation rates are often suboptimal. A better understanding of general practice as a key contextual setting for screening could help inform the development and adoption of, for example, electronic reminder interventions to support women's participation. AIM To explore the perspectives of general practitioners and relevant staff members engaged in early detection of diabetes after gestational diabetes in order to identify barriers to and facilitators of follow-up screening. DESIGN & SETTING A qualitative interview study undertaken in general practices in the North Denmark Region. METHOD Based on a purposive sample strategy, 18 semi-structured interviews of 12 general practitioners and six staff members, who were either nurses or midwives, were analysed using a reflexive thematic analytical approach. RESULTS Three main themes were formulated: (1) Challenges of addressing women's risk; (2) Prioritisation of early detection of diabetes; (3) System influence on clinical procedures. CONCLUSION Follow-up screening was facilitated by knowledge of guidelines. We found professional collaboration and adaptation support to lead to successful implementation of guidelines in general practice. Supporting GPs and their staff's reflection and discussion of ways to engage in communication and decision-making processes with women is however important, hence it was found to create an important barrier to follow-up screening. Overall, our findings can help inform the future development of interventions to increase uptake.
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