Better Follow-Up Needed for Women after Gestational Diabetes.
Women who develop gestational diabetes during pregnancy are seven times more likely than others to develop type 2 diabetes in the years after delivery. But competing priorities and a lack of follow-up testing are barriers to the continued monitoring and early detection that could reduce the burden of chronic illness, according to a new study led by School of Public Health researchers.
The study, in the journal BMJ Open Diabetes Research and Care, identified low motivation for self-care, work responsibilities, fatigue, and a lack of direction from providers as reasons why few women receive appropriately timed postpartum glucose testing or referral to a clinician for continued diabetes monitoring.
The research team, led by Judith Bernstein, professor of community health sciences (CHS), and Lois McCloskey, associate professor of community health sciences, interviewed 25 clinicians and 27 patients with diagnoses of gestational diabetes mellitus (GDM). The interviews revealed that while women were “highly motivated to address their GDM diagnosis for the sake of the child” they were carrying, they had less appreciation of their own long-term health risks.
“Most were aware of possible consequences of GDM for the child and the seriousness of a diagnosis of diabetes if they actually had diabetes, but most were certain that there would be no future problems after delivery, in part because physicians were reassuring about their ability to provide good care,” the study says.
While some women wanted information about future risks, others “were afraid to hear what was said and thought pregnancy was ‘not a time to hear more problems.’ Providers across specialties had major concerns about patients’ ability to understand and tolerate risk,” the authors said.
They noted that onset of Type 2 diabetes after a pregnancy is “highly preventable” through diet, exercise, and medications that address early stages of glucose intolerance.
Many patients reported not understanding the significance of postpartum testing and referrals for continued monitoring, while some said the test was “problematic” because of the effort involved, including having to fast while breastfeeding. Clinicians acknowledged that follow-up testing after delivery often “falls into a gap” as patients shift to primary care providers.
Practitioners “recognize the increased risk of T2DM (type 2 diabetes) onset following GDM,” the authors said, but existing systems of care “do not incorporate strategies to bridge the gap between complicated obstetrical care and continued monitoring in a (primary care) setting.”
Providers suggested several improvements that could increase testing rates, including discharge instructions that include an appointment for glucose testing, and in-home testing—both ideas that the authors said have merit.
“Simply publishing guidelines for postpartum screening of T2DM is not enough,” Bernstein said. “Continuity of care and access to continuing monitoring for women after a diagnosis of GDM must be more robust than the current standard of care.”
Co-authors on the study included: Christina Gebel, an alumna and former teaching assistant at SPH; Ronald Iverson, assistant professor of obstetrics and gynecology at the School of Medicine; and Aviva Lee-Parritz, chair and associate professor of obstetrics and gynecology at the School of Medicine.